Outlines 



OF 



Clinical Diagnostics 



OF THE 



Internal Diseases of Domestic Animals. 



BV 



Prof. Dr. Bernard Malkmus. 

In Chiirije of the Equine Hospital of the Royal Veterinary 
College at Hannover, Germany. 



TRANSLATED FROxM THE LATEST GERMAN EDITION BY 

PROFESSORS D. S. WHITE AND PAUL FISCHER 

OF THE OHIO STATE UNIVEKSITV COLLEGE 

OF VETERINARY MEDICINE. 



CHICAGO: 
ALEX. EQER. 

1 901. 




n 



Copyrighted at Washington D. C. 

BY Alex. Eger. 

1901. 



Aiitliorized Trfinslritioti. 



Translator's Preface 



IN the translation of Malkmus' "Grnndriss der Klinischen 
Diagnostik" wt- have endeavored simply to reproduce the 
author's ideas wiih the hope that the English and American 
Veterinary Students may tlius be provided with a text-book 
for which they have long felt a need. The needs of the stu- 
dents in the College of Veterinary Medicine of the Ohio State 
University have b^en the direct cause of the hurried under- 
taking of this work. A few short notes which we thought 
proper to add here and there, throughout the book, have been 
placed in [ ]. 

Columbus, O.. David S. White, 

Aug 27, igoi. Paul Fischer. 



Preface* 



THE only safe foundation for the treatment of animal 
diseases is a correct diagnosis of the malady. In 
t'lernpeulic as well as in forensic veterinary medicine ever)- 
thing depends on a correct recognition of the disease. This 
is the most difficult part of veterinary medicine, and methodic- 
al training alone will enable the student to d«.velop into a 
practicing vett^rinarian who can do justice to this demand. 

The following little work which offers a great variety of 
material in a most condensed form is intended as a guide for 
the diagnostician in recognizing and, understanding the 
symptoms of disea.=e. Although it represents the rtsult not 
only of personal, but of veterinary experience in general, for 
the sake of clearness and general appearance the names of the 
numerous authors have been omitted. The results of bac- 
teriological research which have an important bearnig on 
diagnostics have been given due prominence. I have also 
deemed it appropriate to call attention, at the proper places, 
to those diseases or conditions which are considered as factors 
in annulling, or .setting asidtf a sale. It was necessary to ap- 
pend a brief description of the most common diseases in order 
to give the student a general idea of the character of the 
maladies that affect tl:e various functional apparatus, thus 
refreshing his memory and enabling him to institute compari- 
sons between what he learns from his lectures and sees in the 
clinic. 

The true to life representations of the horse and cow, 
which are copied from the "Handbuch dcr Anatomie der 
Thiere fiir Kun.'-tler," 1 owe to the kindness of Prof. Dr. EUen- 
berger and Prof. Dr. Bauni of Dresden. I here most kindly 
thank the.se gentlemen for their nnsilfisli obligingness. 

The publishing house of Gehruder Jiinecke have disre- 
garded both costs and trouble in order to supply good illustra- 
tions and to give the book a neat appearance; to them, too, 
m}' gratitude is due. 

Hainiover, November, 1898, 
Malkmus, 



Table of Contents. 



II. 



The Diagnosis of Diseases i j 

Sj-mptonis 12 

Ascertaining the Diseased Organ 14 

The Recognitioti of the Disease 15 

I. Anamnesis j- 

Ascertaining the Status Praesens lo 

Methods of Examination. 

Inspection , j g 

Palpation 21 

Percussion 22 

Auscultation 26 

General Part of Examination. 28 

1. Signalment 28 

2. Habitus ,^ 

30 

I. Attitude of the Patient 30 

II. Condition '^c 

III. Conformation ^r 

Constitutional Diseases of the Bones 36 

I\'. Temperament ^6 

3. The skin o 

I. Condition of the Hair Coat 38 

II. The Skin's Moisture 39 

III. Color of the Skin 40 

IV. Condition of the Skin 40 

V. Swellings in, and Immediately under, 

the Skin 41 

Diseases of the Skin 44 



vni. 

Page. 

4. Examination of the Conjunctiva c j 

I. Color 52 

- II. Moisture of the Conjunctiva 54 

III. Hemorrhages 54 

IV. Swelling 54 

V. Discharge from the Eyelids 55 

5. Bodily Temperature cc 

I. The Normal Temperature 57 

II. Fever 57 

III. High Normal Temperature 58 

IV. Subnormal Temperature 60 

V. Temperature of the Skin 60 

General Infectious Diseases. 61 

B. Special Part of the Examination, 63 

6. Circulatory Apparatus 5-2 

I. Pulse 63 

II. Examination of the Peripheral Blood 

Vessels 69 

III. The Heart. 71 

Dji seases of the circulator}^ apparatus 76 

7. Respiratory Apparatus ng 

I. The Respiratory Movements 79 

II. The Exhalations 87 

III. Nasal Discharge 89 

IV. The Examination of the Nose and 

Upper Air Passages 92 

V. Examination of the Submaxillary 

Eymph Glands 95 

VI. Cough. 97 
VII. Examination of the Larynx and 

Trachea 100 

VIII. Percussion of the Thorax 102 

IX. Auscultation of the Lungs 107 

Diseases of the Respiratory 

Apparatus 112 

8. Digestive Apparatus. 1 16 

I. Food and Drink 116 

II. The Buccal Cavity 121 

III. The Throat and CEsophagus 124 

IV. Rumination 125 

V. Vomiting 126 



IX. 

Page. 

VI. The Abdomen 127 

VII. The Intestinal Evacuations 136 

Diseases of the Digestive 

Apparatus 142 

9. Urinary Apparatus l^c 

I. Manner of Voiding the Urine 146 

II. Examination of the Urine 148 

A. Macro.scopical Examination 148 

B. Chemical Examination 151 

C. Microscopical Examination 158 

III. Examination of the Urinary Organs... 164 

Diseases of the Urinary Apparatus 165 

to. The Sexual Apparatus j55 

I. Abnormally Increased Sexual Desire- 166 

II. The Vulva 167 

III. The Vaginal Mucous Membrane 168 

IV The Udder 168 

V. Diseases of the Male Sexual Organs... 169 
Disea'ses of the Sexual Organs 169 

11. The Nervous System jyo 

I. Psychic Functions 171 

II. Sensibility 173 

III. Motility. 174 

Diseases of the Nervous System... 178 
Specific Examinations. 180 

12. Body Movements jgo 

I. Examination for Immobility 180 

II. Examination for Balkiness, 183 

III. Examination for Heaves 183 

IV. Examination for Epilepsy and Vertigo 186 

13. Diagnostic Inoculation 188 

I. Tuberculosis 188 

II. Glanders 191 

III. Anthrax, Blackleg, Malignant CEdema 

and Wild-und Rinder-Seuche 193 

IV. Rabies 194 

14. The Lymphatic Glands igc 

15. The Blood ig6 

Diseases of the Blood 198 



The Diagnosis of Diseases. 

The object of practical veterinary medicine is manifold, 
but in the main it consists in the restoration of the destroyed 
health of our domestic animals. For this purpose a knowledge 
of the affected organ and of the character of the disease is 
indispensable, because this knowledge offers the only safe basis 
for a rational treatment and a correct prognosis. 

Thus the art of making a correct diagnosis is not only the 
foundation upon which practical veterinary medicine rests, but 
it is preeminently that which elevates medicine to the dignity 
of a science. 

Diagnosis is the art of determining in- 
ternal changes of the body by the aid of ex- 
ternally visible or otherwise appreciable 
changes in the animal's condition or some 
of its organs. 

Since disease is a deviation from normal conditions and 
physiological processes, morbid changes cannot be recognized 
without a knowledge of normal conditions. 

In the classroom the student has no opportunity to study 
the physical characteristics and the physiological functions of 
organs in living animals; he must learn this from personal ob- 
servation and investigation in the clinic. In the clinic he 
must cultivate his senses and learn to hear, see, feel and smell 
in order to be able to judge correctly. 

In the course of his practice different species of animals 
are presented to the veterinarian for clinical examination. This 
gives rise to certain difficulties which, in the main, are ba.sed 



12 CLINICAL DIAGNOSTICS. 

on differences in anatomical structure and ph3'siological func- 
tion of the organs of different animals. The methods of ex- 
amination are about the same for all species. One who has 
thoroughly learned the fundamental principles underlying the 
methods for the proper examination of a horse will have little 
trouble in adapting them to other animals. However, impor- 
tant differences in this respect will receive due consideration. 

A further considerable difficulty in diagnostics, for the 
veterinarian, is his inability to determine the subjective feel- 
ing of a patient. Still, this is of less importance than the 
layman usually supposes. On the other hand, lo compensate 
for this we are in a position, in all cases, to make a complete 
objective examination of the patient in any direction. In this 
respect we have an advantage over the physician who is fre- 
quently denied this privilege and is besides liable to be misled 
bj' the imagination, whim, shame or vanity of the patient. 

A diagnosis consists in the determination of 

i) The sj-mptoms of the disease. 

2) The diseased organ. 

3) The character of the disease — its 
n a m e . 

A Symptom* is any observable deviation from the normal 
state or condition. Anatomy and physiology treat of the 
normal conditions and functions; Symptomatology treats of 
morbid conditions and of perverted functions. 

The particular object of a clinical examination is the de- 
termination of symptoms; it must therefore include the external 
appearance and general behavior of the animal as well as a 
careful inspection of every accessible organ. To avoid mistakes 
or overlooking important factors we must conduct this examin- 
ation according to a definite plan. 

The best plan to follow is to take up the different functional 
apparatus in their physiological order and complete the ex- 
amination of each in its turn. The beginner should memorize 
the scheme and follow it faithfullj'. This is no difficult task 
* [Sy n . — mark-note-sign-token-indicat ion . ] 



DIAGNOSIS OF DISEASES. 13 

since the arrangement is a physiological and therefore natural 
one. 

We propose the following order of procedure: 

I. Anajiiticsis (ascertaining previous history of case). 

II. Asirrfaitiing- f/w Siaiiis P?aese)is. 

A. General examination, 
i) Signalment of the patient. 

2) Habitus. 

3) Skin. 

4) Conjunctiva. 

5) Temperature. 

B. Special examinations. 

6) Circulatory apparatus. 

7) Respiratory apparatus. 

8) Digestive apparatus. 

9) Urinary apparatus. 

10) Sexual apparatus. 

11) Central nervous system. 

C. Specific examinations. 

12)^ Locomotion, exercise in harness or under saddle, etc. 

13) Diagnostic inoculations. 

14) Examination of lymphatic glands. 

15) Examination of the blood. 

The anamnesis should be procured and the general and 
special examination should be made at least once during the 
first visit to the patient. If the diseased organ or organs have 
been ascertained they must be carefullj^ re-examined at every 
subsequent visit, at the same time we must be on the alert for 
the appearance of possible symptoms in other organs. 

The specific examinations are made only when necessary 
for clinching the diagnosis. 

Sometimes external influences bring about certain con- 
ditions of the healthy body which must not lie interpreted as 
symptoms of disea.se, although they might, under other cir- 
cumstances, be such; e. g. a horse refuses its feed — this is a 
frequent occurrence in gastro-intestinal affections or in the 



14 CLINICAL DIAGNOSTICS. 

course of severe general diseases, but it may also be due to an 
excitable temperament of the animal or to the fact that the food 
in itself is undesirable — spoiled, mouldy. Hence the practi- 
tioner must always endeavor to ascertain the cause of the 
symptoms, whether the deviations from the normal are really 
due to disease or to external conditions. 

Rapid respiratory movements may be due to a disease of 
the respiratory apparatus or to some other affection; again, 
they invariably occur after bodily exertions, and high temper- 
atures, even when the animal is at perfect rest, will cause the 
respiratory movements to become accelerated. 

To avoid confusing symptoms produced by muscular ex- 
ercise, or other efforts on the part of the animal, with symptoms 
of disease, the patient should first be examined in a state of 
rest. Furthermore, all conditions that could possibly influence 
normal physiological processes must ever be taken into con- 
sideration; for example, we will mention age, oestral period, 
pregnancy, fright on part of the animal, etc. 

After noting the symptoms of the disease we come to the 
most difficult part of clinical diagnostics, viz: 

Ascertaining the Diesased Organ. There are only a few symp- 
toms which point with certainty to an affection of a definite 
organ, fewer still enable us to recognize the character of the 
disease; these latter are called pathognomonic symptoms. As 
a rule all symptoms must be first noted and then considered 
as a whole, always bearing in mind the principles of general 
and special patholog}'. 

We distinguish different kinds of symptoms: 

1 ) Direct symptoms are due to the fundamental disease 
or morbid process. 

2) Indirect or accidental symptoms are due to complica- 
tions of the fundamental disease. 

3) Local symptoms belong to the affected organ or to 
the disease center. 

4) General symptoms belong to the body as a whole 



DIAGNOSIS OF DISEASES. 15 

and are due to a sympathetic relationship of all the 
organs. 

To determine the affected organ all ascertained symptoms 
are carefully reconsidered in the order in which they were de- 
termined. The healthy apparatus are for the time being dis- 
regarded, the diseased apparatus are given special consideration. 

A variation in the normal functional activity of an organ 
does not /;/ itself indicate disease, it may simply be a compen- 
satory variation (one due to an opposite variation in a similar 
organ) due to the primary morbid condition. The therapeut- 
ist's object is to ascertain the primarily affected 
organ, bring about a cure in this and secondarily cause the 
sympathetically affected organ to regain its natural condition 
and activity. 

To discover the primarily affected organ requires a knowl- 
edge of the morbid processes that take place in each organ and 
of the direct, indirect, local and general symptoms produced 
by them. This requirement is still more important for the 
final aim or ultimate purpose of diagnostics, viz: 

The recognition of the disease itself according to kind, 
etiology, intensity and duration. The method 
of examination of each organ will therefore be followed by a 
short description of the most important diseases of each. A 
correct diagnosis and a rational treatment requires a thorough 
investigation into the cause of the disease. 

It is not enough to diagnose a nodular, itching and spread- 
ing eruption of the skin, we must also determine the cause or 
our prognosis and treatment cannot be correct and rational. 
Such eruptions are due to various causes and an exact knowl- 
edge of them is an important item. The same may be said of 
affections of internal organs. 

A final diagnosis is made either by considering the deter- 
mined symptoms directly {ditect diagnosis) or by a process of 
exclusion, i. e. , we review in our mind all diseases in which 
the symptoms ascertained occur, or in which some of these 



16 CLINICAL DIAGNOSTICS. 

symptoms occur, and then we exclude those diseases in the 
course of which, if present, we usually observe additional 
symptoms ( differen tial diagn osi's) . 

Following one or the other of these methods usually 
suffices to make a diagnosis. Not infrequently, however, even 
the experienced practitioner must content himself with limit- 
ing his diagnosis to a statement of the general character of 
the disease and reserve the privilege of expressing his final 
opinion {special diagnosis) pending further observation and 
developments. This is particularl}^ the case in the first out- 
breaks of infectious diseases when localized changes are ab- 
sent. We also distinguish between a definite, a probable, and 
a possible diagnosis. 

The difficulties encountered in diagnosing internal diseases, 
vary considerably; in some cases a good anamnesis suffices as 
a basis for making a definite diagnosis: epilepsy, parturient 
paresis. In other cases the experienced practitioner requires 
but a glance at the patient: tetanus. The rule, however, is 
never to make a diagnosis until a thorough and careful ex- 
amination of the patient has been made; but here, too, care- 
full}' cultivated powers of observation and extensive experience 
go a good way. To acquire either of these of course requires 
continued carefully and methodically conducted examinations. 

If the diagnosis cannot be made definite in every respect, 
be cautious in your prognosis and therapeutics. 



I. Anamnesis.' 

Full statements on the part of the owner or attendant, 
procured by cautious questioning, concerning the previous con- 
dition of the patient, the beginning and previous course of the 
disease (anamnesis) are of great importance in diagnostics, in 
fact there are some diseases, like epilepsy, for example, that 
can as a rule be diagnosed in no other way because it is only 
in exceptional cases that we have an opportunity to observe a 
typical epileptic fit. 

As far as the veterinarian is concerned the anamnesis is 
limited to the observation of the immediate surroundings of 
the animal. In questioning attendants speak to them in a 
pleasant tone and manner and use words and expressions with 
which they are familar; this tends to infuse confidence and 
the result is that the information thus obtained wull be more 
apt to be reliable. 

A well drawn up anamnesis speaks for the technical 
ability of the veterinarian as well as for his knowledge of the 
etiology of the diseases of our domestic animals which are 
kept under the most variable conditions. 

i) How long has the animal been sick? 
We may learn by this question whether the disease is an acute 
or a chronic one, and perhaps also the stage of development 
which the disease has reached. Frequently the time given 
by the owner or attendant is much shorter than the actual 
duration of the disease. 

2) What symptoms has the animal 
shown? In the beginning? Later on? The objective ob- 
servation of the owner must be carefully sifted out from his 
subjective interpretation of them. 

3) What, in your opinion, could be the 
cause of the disease? We cannot search for the 
causes until we know the symptoms. 

1 (ittiiivi/(jir, a recalling to mind; recollection. 



18 CLINICAL DIAGNOSTICS. 

Where and under what conditions did 
the animal get sicjc? Feed, care, etc., play an im- 
portant role in the etiology of diseases of animals; therefore 
the veterinarian must be informed not only as to the kind and 
character of the feed but also as to soil conditions, water, etc., 
otherwise he cannot intelligently trace the cause of the disease. 

4) A number of animals affected by the same disease 
always points to a common cause, viz. : infection or intoxica- 
tion {^poisoning). The frequent recurrence of a disease in the 
same stable points to the existence of a permanent cause. 

5) It is of especial importance for the veterinarian to 
know whether any previous treatment has been resorted to 
and what effect this may have had. Quacks often administer 
draughts containing solid particles in suspension; these 
draughts, instead of taking their usual course may enter the 
trachea and thus produce a fatal pneumonia. In removing 
the contents of the rectum its wall or mucous membrane is 
also often injured. In such cases the veterinarian must ex- 
ercise care and judgment and call the owner's attention to any 
existing danger. 

Although the main points in the anamnesis should be de- 
termined before we begin our objective examination, other 
questions will present themselves in the course of the latter. 
Thus, when examining the larynx we may inquire whether 
the animal coughs, and when examining the digestive ap- 
paratus inquire as to condition of bowels, frequency of evacu- 
ation, etc., in this way gradually completing our examination. 

The value of a good anamnesis consists in the fact that 
not infrequently it is sufficient to base upon it a definite diag- 
nosis, i. e., careful objective observations of the layman may 
in some instances be substituted for our examination. How- 
ever, the veterinarian must always be cautious in complying 
with the oft made request of owners to treat their animals in 
absentia. Although the medicines prescribed under such cour 
ditions may do no particular harm, rational treatment thus 
delayed may prove to be a positive injury. 



II. Ascertaining the Status Praesens. 

To determine pathological phenomena we resort to all 
those methods which throw light upon the physical state and 
functions of the different organs. In doing this we should 
endeavor to follow a definite plan and not proceed without 
system. The following methods are generally employed and 
in the order given: 

1. Inspection. 

In examining the different parts of the body it is always 
best that we first regard that which can be observed with the 
unaided eye. Students are apt to lay their hands upon the 
patient too soon. Superficial abnormalities are described ac- 
cording to their seat, size, color and other external manifesta- 
tions; the size and form usually being compared with common 
objects, unless an exact description is desired \Then actual 
measurements are made. 

The odor emitted by the se- and excretions and the res- 
pirations is also noted. 

In designating the seat of visible pathological conditions 
the exact anatomical region occupied by them should be indi-. 
cated. 

Regions of the Body, 
1. Head. 

A. Face. 

1. Nasal region wilh dorsum of nose, tip of nose, nasal 

openinj^s. [Nostrils.] 

2. Labial region, with upper and lower lips, interlabial 

space and chin. 



20 CLINICAL DIAGNOSTICS, 

3. Buccal region. 

4. Infraorbital region. 

5. Ocular region, 

6. iMasseteric region with maxillary articulation. 

7. Intermaxillary space. 




II. Neck. 



Fig. ]. 

B. Forehead, 

8. Frontal region. 

9. Occipital region with forelock. 

10. Temporal region with the temporal fossa, infra-temporal 

groove and auricular region. [Ears.] 

11. Parotid region, which merges below into the laryngeal 

region, 

12. Tracheal region with jugular groove, at the lower end of 

which is the supra-clavical fossa. 

13. Cervical region with crest and mane. 

14. Lateral cervical region, sides of neck. 



ASCERTAINING THE STATUS PRAESENS. 21 



111. Chest. 



15. Withers and dorsal region. 

16. Lateral pectoral region [sides of chest] with scapular 

region, cardiac region, costal region. 

17. Sternal region. 

18. Anterior pectoral region. [Breast.] 

IV. Abdomen. 

19. Epigastric region with xiphoid space. 

20. Mesogastric region with umbilical space, iliac region 

(flank with '•hollow of flank") and the lumbar 
region. 

21. Hypogastric region with pubic and inguinal region. 

V. Pelvis. 

The diflFerent divisions of the pelvis are named according to their 
anatomical parts; the sacral region is called the croup, the external 
angle of the ilium the '"hip," just below the anus the perineal region; 
the anal region, pubic region and inguinal region. 

The various portions of the extremities are designated according to . 
the names of the bones constituting them. 

2. Palpation. 

Palpation consists in feeling the part to be examined with 
the hand or finger tips. Its object is to gain information 
through the sense of touch as to the consistency, extent, tem- 
perature and sensitiveness of morbid processes, and permit us 
to recognize abnormalities which do not lie far below the sur- 
face. Palpation is of especial importance in taking the pulse. 
The abdominal viscera can be explored (palpated) through 
the rectum and the anatomical position, and condition of the 
contents determined. 

From the difference in consistency of the parts palpated, 
conclusions as to their physical nature may be drawn. The 
following peculiarities may be distinguished on palpation: 

1. A part is doui^hy when it feels soft and accepts finger 
imprints which it retains for a few moments, when the de- 
pressions are again filled. Tissue is of a doughy consistency 
when infiltrated with serum: {ivdcma^. 

2. A part is firm when it is of the consistency of normal 
liver. According to the part' s resistance to the touch it may be 



22 CLINICAL DIAGNOSTICS. 

Jirm, tendinous, solid or hard as bone. A cellular infiltration of 
tissues (phlegmona) or the presence of tumors made up of 
cells, will lend to a part ay?rw consistency. 

3. A part vi fiuduating when it is soft, elastic and undu- 
lates on pressure. Only fluids admit of such a rapid trans- 
mission of pressure (pus, blood, lymph, serum). If the 
tissue surrounding the fluid is not tense, waves are seen to 
pass over the surface of the swelling (true or soft fluctuations). 
Soft-elastic (fat) tissue or tissue impregnated with a quantity of 
fluid may also show fluctuation; this undulating consistency 
is spoken of zs pseudo-fluctnation. 

4. A part is emphysematotis when it presents a puffy 
swelling which crackles and shifts on palpation; it is due to 
the presence of air or gas in the tissue (emphysema). 

3. Percussion. 

By percussion we understand striking the surface of the 
animal body so that the parts thus set in vibration emit audi- 
ble sounds. The '' percnssio7i- sound'" thus produced will difEer 
with the physical condition of the vibrating parts, and these 
differences are so well marked that definite conclusions can be 
drawn from them. 

Methods of percussion. Percussion can be practiced without 
the use of instruments [so-called immediate percussion] on 
small animals or large animals thin in flesh. The index or 
middle finger of the left hand is held firmly against the part 
to be percussed and struck with the middle finger of the right 
hand. The striking finger should be held somewhat curved 
and stiff. The advantage of immediate percussion lies in the 
facility with which the finger may be placed between the ribs 
and amid the long hair of some dogs and the wool of sheep. 
For the larger animals the sounds obtained from this finger-to- 
finger method of percussion are not definite enough for practi- 
cal use. 

In the immediate method of percussion, however, the 



ASCERTAINING THE STATUS PRAESENS. 26 

sound can be augmented by employing the percussion hammer 
to strike the finger which is applied to the part (finger-hammer 
percussion). 

The pleximeter and hammer (plexor) are most com- 
monly used in practice [so called mediate percussion] as they 
permit not only of gentle percussion but the part to be ex- 
amined can be struck a heavy blow which sets deep-lying parts 
into vibration. The pleximeter should be so held that its whole 
surface is in firm contact with the part to be percussed. In 




Fig. 2, Plexor. Fig. 3, Plexiraeter. 

thin animals the pleximeter should never be applied across two 
ribs, but should be made to occupy an intercostal space that 
the air between it and the body does not modify the sound. 
The force with which we use the hammer depends upon the 
thickness of the walls of the part percussed. [In fat animals 
it is necessary to use more force than in lean ones] , 

I^sually two or three strokes suffice to bring out clearly 
the character of the .sound. For comparison it is advisable to 
percuss corresponding parts on each side of the body. 

For a better perception of the percussion-.sound it is ad- 
visable to select a suitable place. A room with closed doors 
is the best; in very large rooms or out of doors the application 
of percussion is never satisfactory. 

As a rule large animals are percussed while standing, 
though small ones may be placed in a recumbent position upon 



24 



CLINICAL DIAGNOSTICS. 



a table. Although gentle animals may stand quietly during 
the operation, very nervous horses or stubborn cows some- 
times resist. They can generally be quieted by speaking to 
them in an assuring tone and by omitting all rough usage of 
the instruments. Dogs and cats may be held by their owners 
or an attendant. 

The Qualities of Percussion=Sounds. 
A body can onh- then produce a sound when it has lost 
its equilibrium and vibrates by virtue of its elasticity. Two 
principles from the basis of percussion : 

1. Solid, airless parts of the body give forth a flat sound 
of short duration and little intensity. Such a sound is called 
dull , femoral or empty. 

2. If an air-containing organ is set in vibration it pro- 
duces a sound of considerable intensity, duration and tone, 
the so called resonant sound. 






Fig. 4. 

The stronger 
the percussion 
the larger is the 
part which vi- 
brates and the 
fuller the sound. 



Fig. 5. 

The thinner c. 

the overlying 
tissue of the 
thoracic wall 
the more lung 
tissue will vibrate 
and the fuller 
the sound. 



Fig. 6. 

If the volume 
of the air con- 
taining organ is 
small in itself 
then the sound 
is corresponding!}' 
less intensive. 



The clearness of the sound depends upon -the volume of 
the air-containing organ which is vibrating. 



ASCERTAINING THE STATUS PRAESENS. 25 

This explains the varying intensity of the sound over dif- 
ferent portions of the chest wall when the percussion blows 
are applied with equal force. The resonant sound gradually 
merges into the dull femoral as we approach the forward and 
upper portions. 

The resonant sound may be subdivided into : 

1. The tynipanHic sound, which approaches a musical 
tone. 

2. The //^// sound (pulmonary resonance). 

The tj'nipanitic and full sounds are both re.'^onant in char- 
acter, and in both the degree of clearness can varj- until they 
become identified with the dull sound. The intermediate 
stages are comparatively dulled and dull tympanitic. 

Occurrence of the Different Qualities of Percussion-Sounds. 

According to the above classification there are three kinds 
of percussion-sounds: The full (pulmonary resonant), the 
tympanitic, and the empty. 

1. The full sound is found over normal lung, the air in 
the alveoli, and the lung tissue, and thoracic walls vibrating. 
When the intestines are so distended with gas that when per- 
cussed their walls vibrate with their contents, a full sound is 
emitted. 

2. The tympanitic percussion-sound has a varied origin. 
It is heard : 

a. Over cavities containing air which communicate with 
the outside world, their walls being either firm or yielding: 
trachea, caverns in the lung communicating with bronchi. 
The pitch of the sound depends upon the size of the cavern 
and its communicating opening. 

b. Over enclosed air-containing cavities the walls of 
which are little distended, hence over the stomach and bowels. 

c. Over lung tissue the ten.sion of which has become 
diminished, (atelectasis, beginning hepatization). 

3. The empty (femoral) sound is heard when percuss- 
ing over solid tissues which do not contain air. As the most 



26 CLINICAL DIAGNOSTICS. 

forcible percussion does not produce vibrations at a point more 
than 10^'°^ below the surface, a dullness can be perceived over 
the normal lung when the chest walls are covered with heavy 
muscles, fat, or oedematous swellings. 

The sound is comparatively dulled when air-containing 
parts of limited dimensions are percussed (borders of the lung, 
and under thick thoracic wall) or if small airless spaces lie 
amid those containing air (nodular thickenings in the lung). 

During the application of percussion we should note the 
resistance the part offers to the hammer or striking finger. 
[To understand what is meant b}- this the student should 
strike with the plexor some solid object, as a brick wall, and 
compare it with the feeling experienced when the human chest 
is percussed] . By placing the index finger on the back of the 
hammer the resistance can be better appreciated. From the 
resistance the amount of vibration that can be induced in the 
underlying parts may be determined, the greater the former 
the less developed the latter. For this reason solid, airless 
parts like muscle give a shallow percussion-sound and causes 
the hammer to suffer a jar when they are struck. 

Determining the Boundaries of an Organ from the 
Percussion-Sound. 

The boundary of an organ can be determined by percus- 
sion only when the organ lies superficially and emits a percus- 
sion-sound which differs from that of its neighborhood. For 
this reason the boundar}- of the heart against the lung or the 
lung against the bowels may be defined by percussion. 

4. Auscultation. 

By Auscultation, applying the ear to a part, we -seek to 
obtain information, through the .sense of hearing, as to the 
physical state or condition of deep-lying organs. For this 
reason auscultation is practiced upon the heart, lungs and in- 
testinal tract. 



ASCERTAINING THE STATUS PRAESENS. 27 

In human medicine auscultation is usually practiced with 
the help of instruments {mediate aicscultation), the so called 
stethoscope etc. being employed. [In veterinary medicine, 
however, the use of such instruments is very limited, the 
heavy hair coat materially interfering with and so modifj-ing 
the sounds that false conclu.sions may be drawn. To a limited 
extent the phonetoscope is useful in auscultating heart sounds, 
but the hairs over the cardiac region should first be thor- 
oughly moistened or oiled] . 

By simply applying the ear firmly to the part, better re- 
sults can be obtained than by the use of instruments. In case 
the skin is dirty, blistered, or the animal is lousy, a towel can 
be placed between it and the ear. To guard against being 
bitten or kicked an attendant should hold the patient by the 
head. In large stables containing a good many animals the 
noises they produce may interfere with auscultation; if it is 
essential to diagnosis or prognosis, the patient should be ex- 
amined in some quieter place. 



A. The General Part of the Examination. 

I. Signalment. 

By the Signalment is meant a description of the patient for 
identification by peculiar marks or characteristics. For foren- 
sic purposes and special cases the proper taking of the signal- 
ment is of great importance. It is further of some value in a 
diagnostic sense and is sometimes taken into consideration 
therapeutically. 

It includes : 

I. Kind of animal. Many diseases are peculiar to certain 
genera while they do not occur in others. This is especially 
true of the infectious diseases as, for instance, the horse suffers 
from strangles, and glanders; the ox from contagious pleuro- 
pneumonia (lung plague), malignant head catarrh, and swine 
from hog cholera and swine plague. There are also special 
sporadic diseases which owe their origin to the peculiar ana- 
tomical or physical makeup of a genus. As examples, may- 
be mentioned traumatic pericarditis of the ox; ruptures of the 
stomach and roaring in the horse. 

II. Sex. Diseases of the sexual organs are not common 
in animals, but sex is of influence in the appearance of some 
diseases. In stallions inguinal hernias which cause symptoms 
simulating colic occur; mares during the period of heat may 
act as if they were suffering from some brain disease (act like 
dnmniies) or may balk or show obstinacy when at work. In 



GENERAL PART OF EXAMINATION. 29 

the OX urethral calculi are not uncommon. The condition of 
pregnancy is a.s of great importance from the diagnostic as from 
the therapeutical standpoint, becau.se this condition may in- 
duce physiological symptoms that would be con.sidered patho- 
logical in non-pregnant animals. In pregnant animals cau- 
tion is demanded in the choice of drugs. 

III. Color and white markings. For diagnosis the color and 
markings are of less importance. White horses frequently 
suffer from melanotic tumors that are either .superficial or 
located in internal organs. White areas are more predisposed 
to exanthemas, sunburn and scratches. 

IV. Agz. Many diseases occur either exclusively or gener- 
ally in youth. Rhachitis, diseases of the navel, strangles in 
colts, scours in calves and distemper in puppies are examples. 
In old individuals diseases due to the animal's use are more 
frequent as are also chronic diseases of organs. 

The age is ahso of influence upon the prognosis in as much 
as healing, all things else being equal, is more to be hoped for 
in the young individual than in the old one. In old animals 
where the prognosis is a doubtful one all treatment is fre- 
quently' omitted on economic grounds. 

V. Size. Size is of importance in po.sology only. 

VI. Breed. In well bred animals the reaction against the 
encroachment of disease is more energetic and the symptoms 
are more pronounced. Certain breeds are more able to with- 
stand infectious and sporadic diseases than others, this must 
be considered in making a prognosis. Breed is also taken 
into consideration in the treatment of diseases. Well bred, 
fine skinned, .sensitive horses yield to the action of certain 
drugs more readily than those of the opposite type. This is 
especially true where outward applications (turpentine blisters) 
are to be made. 

VII. Use and Care. The use to which the animal is put 
and the care taken of it is closely connected with the etiology 
of disease. Certain uses and also neglect, predispose to varied 
forms of di.sease. 



30 CLINICAL DIAGNOSTICS. 

2. Habitus. 

By the term habitus we mean the general or external as- 
pect or characteristic appearance of the patient, which is de- 
termined by its physical attitude, condition, conformation and 
temperament. It offers a convenient aid in diagnosis, one 
that can be readily observed and that, in many respects, is of 
great importance. Not infrequently a diagnostic conclusion 
in a clinical case is reached largely through the impression 
the patient makes upon us by its habitus. 

I. Attitude of the patient. Healthy horses as a rule 
remain standing during the day, or if lying down they imme- 
diately rise to their feet at the approach of a stranger. They 
will frequently lie fiat on their side with feet extended, pro- 
vided the halter strap be long enough and the stall of sufficient 
width. 

Healthy cattle (bovines) lie down often during the day, 
especially just after feeding, and they are not so prone to rise 
when approached. They seldom lie fiat on the side, but in 
sternal decubitus the limbs are folded under them. 

Healthy sheep jump up when approached and usually run 
away. 

The attitude of sick animals whether standing or lying 
down is often of value in diagnosis. 

Standing attitudes assumed during disease. The head is held 
stiffly and extended in pharyngitis, [tetanus] , cerebrospinal 
meningitis, muscular rheumatism, malignant head catarrh of 
the ox, and in acute encephalitis of sheep and goats. 

Very sick animals usually hold the head down, and as- 
sume a relaxed, languid attitude, the ears drooping; horses 
rest their feet alternately. 

Cows suffering from severe vaginitis stand with arched 
backi,'^\sS\. held high, and legs spread apart. They do not 
"stand over" readily in the stable, and if driven stop re- 
peatedly to urinate. 

A stiff, quiet attitude, avoiding moving as much as possi- 



GENERAL PART OF EXAMINATION. 31 

ble, is characteristic of very painful affections in the chest or 
abdominal walls (pleurodj^nia, Pleuritis. Peritonitis;. Stal- 
lions suffering from incarcerated inguinal hernia and oxen 
with peritoneal hernia (guttie) stand with the hind leg of the 
affected side held backward and outward. 

Unphysiolo^ical attitudes. Animals afflicted with brain 
troubles (acute or sub-acute encephalitis, "dummies") very 
often assume unnatural attitudes. Horses stand obliquely in 
the stall, the head in a corner, resting against the wall or 
sunk under the feed box. The limbs are drawn well up under 
the abdomen, and not infrequentlj' one leg is placed in a very 
unphysiological position, perhaps crossing its fellow of the 
opposite side. "Dummies" stand unusually quiet and seem 
oblivious of their surroundings. They move without energy, 
and are backed with the utmost difficulty. (See under "Cen- 
tral Nervous System," "Examination of Dummies"). 

Coiitijiucd standing is observed in: 

a. Old, worn-out horses. 

b. Pneumonia and Pleuritis. As a rule if the animals 
lie down in these diseases it is on the diseased side, and for the 
following reasons: because the slight pressure of the ground 
against the body ameliorates the pain, and the pleuritic exudate 
(the effusion in the chest) does not encroach so much upon 
the heart and the still healthy lung. The respirations are 
always more difficult when the animal is lying down. [In 
peritonitis resulting from castration horses very commonly 
remain standing; when forced to move they do so with hind 
legs held in abduction, advancing very stiffly]. 

c. Severe Dyspnoea. Tlie head is held cxteyided to allow 
the air the easiest possible access to the lungs, thus facilitating 
inspiration. 

d. Horses suffering from acute diseases of the brain. 

e. Horses suffering from Tetanus. They stand with 
legs braced like a sazc horse, the head sonieuhai extended and 
held high. It is very difficult for them to step sideways. The 
facial expression is anxious, the ?nemluana nietitans appearing 



32 CLINICAL DIAGNOSTICS. 

plainly before the eye; the tail is carried high and stiff, and 
the gait inflexible and laborious. 

/ies^/fss Sta7iding. Most commonly seen in horses suffer- 
ing from colic. They are restless, lie down, roll, and get right 
up again. In many cases it is only with difficulty that they 
can be kept on their feet; when down it may be equally hard 
to drive them up. They look often at the flanks, paw, strike 
the belly with the hind feet, switch the tail, and stretch as if 
to urinate without voiding urine. At times they sit up like a 
dog. Like symptoms but of shorter duration are observed in 
the ox suffering from invagination of the intestines, torsion of 
the uterus in cows and from urethral stones and peritoneal 
hernia in steers. 

Lyin^ postures assumed during Disease. Animals found 
lying down and that can not be made to rise should be 
examined very carefully. We should first try to drive them 
up by speaking to them in a sharp tone of voice and assisting 
them by mechanical means. It is important to determine 
whether they are really unable to rise or whether they are 
obstinate and will not rise (malingerers). 

If the animals have lain for a long time on one side, it is advisable to 
turn them over before attempting to drive them up. The same should 
he done when after a fruitless effort to get an animal onto its feet, it falls 
back again to the ground and we make a second attempt to make it 
stand. 

To bring recumbent horses to their feet it is expedient, after placing 
them on the sternum, to pass the end of a long halter rope through a 
convenient ring in the wall, and keep it pulled taught; the hind legs 
should be doubled under the body in a natural position and the fore ones 
extended in front. By speaking to the animal, striking it over the ears 
and nose, and lifting by the tail, we may assist it to regain its feet. When 
this method fails a sling should be placed under the body and the animal 
raised with block and tackle. 

The ox is often hard to induce to stand up after it has been down for 
a time. It may be able to get up, but through obstinacy will not do so. 
Whipping and beating in such cases is usually of no avail; yelling in the 
animal's ear, setting a dog on it or tieing its nose shut may be tried. 
[By placing a rope around the body so that it passes beneath the brisket 



GENERAL PART OF EXAMINATION. 



33 



in front and the ischii behind, we have improvised a handle by which 
several persons can lift the malingerer to its feet]. 

Animals are unable to stand: 

a. In Tetanus. Horses suffering from tetanus, if down, 
are as a rule unable to stand up without help, as the spasmodic 

Fig. 7. 




Horse with Azoturia. 

contractions of the extensors of the limbs prevent it. When 
recumbent, the upper pair of legs do not come in contact with 
the ground. The animals are very restless and bedewed with 
sweat. 

b. In Azoturia. Horses suffering from acute a/.oturia 
make vain efforts to stand. They are sometimes only partial- 
ly successful, the fore part of the body being raised and 



34 



CLINICAL DIAGNOSTICS. 



supported by the front legs, but the hind limbs are unable to 
bear their share of the weight, breaking down under it. 

c. In Spinal paral y sis from Fractures of Vertebrae. 
Thepatients lose control of the hind parts which are no longer 
sensible to pain [pin pricks] . Sometimes, however, reflex 
spinal convulsions attend ' 'broken back." Dogs with paralyzed 
hind parts usually sit sideways, the legs directed away from 
the body. 

d. Anti-and-Post-partum Paresis. Occurs 
in cows before or after calving. The animals seem to be in 
comparatively good health, have a good appetite, but can not 
regain their feet. There are no further symptoms of disease 
or injury. They often lie stretched out on the side. [Prog- 
nosis is favorable] . 

Fig. 8. 




Cow with Parturient Paresis. 

e. Milk Fever (parturient paresis). The cow lies in 
a comatose condition on the left side as if in profound sleep, the 
head resting against the right chest. Sensitiveness of the 
whole body is diminished. 

f. Cramp of the Ne ck (cerebro-spiual meningitis). 
After showing symptoms of stiff, wry neck, while standing, 
paralysis follows. The patients lie flat on the side with the 
head drawn backward, the body convulsed with spasms. 

Old, worn out horses are hard to get upon their feet once 
they have lain or fallen down. When animals are suffering 



GENERAL PART OF EXAMINATION. 35 

from severe pain in the legs and feet (founder) or when lying 
on an injured limb (fracture), they can as a rule rise only 
with the greatest difficulty. Colic patients, when down, gen- 
erally do not get up promptly. 

II. Condition. The condition of the animal is recognized principally 
by the rotundity and fullness of development of the body. Cold blooded 
horses usually have well rounded forms because the muscles are of large 
size and surrounded by well developed fat deposits. The condition as to 
flesh is influenced by the quantity and quality of the food and the use 
and purpose for which the animal is intended and fed. Continued hard 
work reduces the fullness of the body outline, causing the conformation 
to appear angular. 

When the digestive tract is affected with disease, whether 
local or gtMieral, the condition cf the animal becomes reduced. 
A gradual but continual loss of condition, notwithstanding 
that the appetite and food are good, always points to chronic 
disease, but not necessarily to disease of the digestive tract. 
When the digestive tract l>ecomes diseased the appetite is 
impaired. 

Depending upon the use and purpose of the animal we 
distinguish the following kinds of condition: Prime, very 
good, tolerably good, fair and bad. A gradual, progressive 
general emaciation is called Cachexia. Rapid emaciation ap- 
pears in purpura hemorrhagica and in severe infectious dis- 
eases. Excessive corpulency (obesity) is common in bulls 
and dogs; in slaughterable animals it is desired. 

III. Conformation. It is advisable to classify horses ac- 
cording to their use into heavy and light draft, carriage and 
saddle horses. The classification is based upon the animal's 
conformation. To judge of the conformation correctly we 
.should take into consideration the depth of the body, breadth 
and depth of chest, curvature of the ribs, strength and angu- 
lation of the joints, and the attitude of the limbs when stand- 
ing naturally. 

Horses with fiat, small chests possess poor staying quali- 
ties, the lungs corelatively l^eing small. Horses with fiat, not 



•^6 CLINICAL DIAGNOSTICS. 

well sprung ribs, tucked up abdomens and long limbs, are as 
a rule poor feeders. As such animals show continually poor 
appetites for food, the bowels are not kept well filled, hence 
the body appears deficient in depth. [The horseman speaks 
of such a conformation as being "herring gutted"]. Heart}' 
horses which are good feeders, show on the other hand, better 
developed abdomens, the bowels being distended by the large 
quantities of food they contain. The more voluminous the 
food, the greater the circumference of the belly. [The abdom- 
inal circumference is further increased in pregnancy and in 
diseases causing exudates to accumulate in the abdominal 
cavity ascites] . 



Constitutional Diseases of the Bones. 

Rachitis and osteomalacia. Both of these diseases are characterized by 
the bones being deficient in lime salts. Such bones possess little power 
of sustaining weight, hence they suffer change in form when the weight 
of the body must be borne by them. 

a. I^achitis appears only in youug animals, mostly in pigs and 
puppies. Pathologically the disease may be considered to be a remain, 
ing softness of the bones, the epiphyses becoming enlarged, the diaphyses 
bent An upward curvature of the spine /^V is called kyphosis, a 

downward 'Ni-«^ lordosis, a lateral \ scoliosis. Animals suffering from 

rachitis remain lying a great deal, find trouble in regaining their feet, 
and locomotion is dii?icult. 

b. Osteomalacia. Fragility of the bones is seen only in adult animals 
(cattle). The animals lie down continuall}', are weak, eat but little, 
and becomes thin in flesh. The bones of the extremities become brittle; 
spontaneous fractures, decubitus, and death ensue. 

IV. Temperament. By temperament we mean the mental 
attitude the animal assumes toward impressions perceived 
through the medium of the organs of sense. An animal's 
knowledge of what is going on about it is obtained through 
the instrumentality of the bodily senses of sight, hearing. 



GENERAL PART OF EXAMINATION. 37 

smell, and touch. We distinguish between a lively and a 
phlegmatic temperament, comparing the power of quick percep- 
tion with its opposite slow comprehension. Too much tend- 
ency in either direction will affect the usefulness of an animal. 

Animals of fiery disposition often show temper by being 
stubborn, vicious, balky, or they are very nervous, anxious, easily 
frightened, which reduces their economic value. Young 
animals, especially horses, are often restless and like to play. 

Animals of a very phlegmatic temperament may be so 
slow to move as to impair their usefulness. 

The sort of temperament possessed by an animal is shown 
by its external appearance. The countenance, expression of 
the eye, play of the ears, and quickne.ss of movement form 
sources from which the temperament and disposition may be 
judged. The facial expression and eye give information as to 

the mental condition. 

Blind horses are often scary; they employ the sense of 
hearing, moving the ears in a lively manner to take the place 
of the lost sense of sight, at the same time holding the head 
still. This may cause us at first sight to suspect that the 
animal is suffering from a brain disease. Old horses are not 
so sensitive to outside impressions as colts. Some colts, how- 
ever, are little observing of their surroundings, appearing 
dull, stupid and lazy, without suffering from disease. Great 
fatigue produces temporary physical and mental depression 
also temporary loss of appetite in phlegmatic individuals. 

Feverish diseases affect the temperament, making the 
animal affected sluggish in its movements. In animals of fiery 
temperament this is not so noticeable. 

In animals suffering from severe, .serious disea.ses, the 
temperament can become so changed that vices, such as crib- 
bing, biting, kicking, etc., are no longer indulged in. The 
countenance appears blank, expres.sionless, staring, locomotion 
slow and unsteady. A few hours before the fatal termination 
of a disease, the normal tonus of the ti.ssues is lost, the muscles 
relax, especially those of the face, forming the so-called Hip- 



38 CLINICAL DIAGNOSTICS. 

pocratic countenance (facies Hippocratica), one of the symp- 
toms of approaching death. 

3. The Skin. 

The condition of the skin indicates the state of health. 
The condition of the skin is affected not only in local diseases 
of that organ, but in many maladies of a general nature, 
involving internal viscera. An examination of the integument, 
therefore, is of importance to diagnosis. The skin is examined 
by inspection and palpation; in local diseases the microscope 
is employed. An examination of the skin includes the fol- 
lowing: 

I. Condition of the hair coat. In horses in good condition 
the hair is usually short, fine, flossy, and lies smoothly. Horses 
running on pasture or kept in unsanitary stables, show a lo7ig, 
histcrless, rough, bristling, hair coat. If the condition of the hair 
coat is bad, notwithstanding good care and shelter, it may be 
assumed that the animal is suffering from ill health. The 
appearance of the hair coat is influenced mostly by chronic 
diseases. Temporarilj' the hairs may become erect when the 
animal is carrying increased temperature (chill) or from the 
effects of cold air or water. 

Sheddingof thehair. In horses and cattle a partial 
shedding of the hair occurs normally each fall and spring. In 
the fall the long, soft winter coat appears; this is shed the 
following spring. [Animals kept blanketed in warm stables 
retain a short hair coat throughout the winter.] Good 
care and proper food hasten the shedding of the hair, contrary 
conditions tend to postpone it. When the winter coat is 
retained during the summer months, it indicates chronic dis- 
ease of nutrition. 

When horses which have been poorly kept pass into good 
hands and receive nourishing food and good attention, an 
unusually early shedding of the winter coat follows. 

Alopecia. A loss of hair over the whole or a large part of 



GENERAL PART OF EXAMINATION. 39 

the body {alopecia) sometimes quickly follows the recovery of 
an animal from a severe infectious disease (contagious pleuro- 
pneumonia of the horse). A gradual loss of coat accompanies 
chronic, cachectic diseases in sheep and dogs. In chronic dis- 
eases affecting nutrition the hairs become loose, and may be 
easily removed by pulling or rubbing. Horses clipped late in 
the season (November, December) grow short winter coats; 
when these are shed the following spring, the skin is left 
partially denuded of hair, giving the animal a half-naked ap- 
pearance. 

Where the hairs fall out in patches, and lesions are found 
in the skin, a disease of the integument is present. 

11. The skin's moisture. The skin is kept continually moist 
by the secretions of the sweat glands. In healthy animals 
at rest the supply of secretion is just sufficient to keep pace 
with the loss by evaporation, so that the skin does not feel 
wet but soft and pliable. The skin's moisture is increased by 
exercise, high atmospheric temperatures and nervous excite- 
ment. Sweating does not become visible in swine, sheep, dogs, 
and cats. 

In disease a more or less profuse outbreak of sweat 
{hypcridrosis) appears: — 

1. when an animal is much weakened from acute or 
chronic disease. 

2. in severe dyspnoea, where it is compensatory, assist- 
ing the lungs to throw off effete matter; stenosis of the an- 
terior respiratory passages, diffuse pneumonias, pulmonary 
emphysemas, and organic heart diseases. 

3. in painful maladies: founder, colic, enteritis. 

4. in diseases painfully affecting the muscles : tetanus, 
epilepsy, azoturia, cerebro-spinal meningitis. 

Normally, perspiration is accompanied by a hyperemia of 
the skin. If this congestion be absent, the sweat being ex- 
creted upon a cold skin surface ' 'cold sii'cal" is spoken of, a proc- 
ess to be judged unfavorably from a prognostic standpoint. 

Local sweating! hy peridrosis localis ) , or sweat appear- 



40 CLINICAL DIAGNOSTICS. 

ing on only one side of the body (hemidrosis) is seen at times 
to accompany diseases of the nerv^ous system. 

A decrease in sweat secretioti (hypidrosis) 
can be .so well developed that the skin feels dry (anidrosis). 
This condition can best be appreciated on the muzzle of the 
ox, the snout of the hog, or the nose-tip of the dog. These 
parts in healthy animals are moist and nearly cold. During 
high fever, severe diarrhea, diabetes insipidus (polyuria) 
hypidrosis is a common attending symptom. In severe dis- 
eases where life is threatened, the nose feels cold and dry. 

III. Color of the skin. The hair and pigment prevent us 
from seeing that color of the skin which is caused by the 
blood and other ph^'siological fluids flowing through it. With 
the exception of the horse, nearly all white-coated animals 
have non-pigmented skins. [Horses having white or grey hair 
coats show pigmented skins, the white-born (albino) horses 
forming an exception. The parts of the skin which show 
white markings (legs, forehead) are as a rule not colored]. 

Chronic discharges from natural openings (the eye, nose, 
vulva) cause a loss of pigment from the portions of 
the skin over which they flow. 

An injection (reddening) of the skin is only of diag- 
nostic importance when not produced by local diseases of the 
integument. A diffuse reddening of the skin, namel}^ of the 
abdomen, neck and between the thighs, is seen in swine 
erysipelas (Rothlauf ). Red spots, often angular in shape, 
accompanied by swelling of the skin, appearing usuall)' over 
the neck and along the back, are seen in urticaria in swine. 
The skin becomes bluish re d( cyanotic) when the blood is 
heavily charged with carbonic acid gas. It is seen in diseases 
causing swelling of the glottis, heart diseases, congestion and 
oedema of the lungs, and in overdriven sheep or swine during 
hot weather. 

Yellow (icteric) discoloration and paleness of the 
skin will be considered under "Examination of the Conjunc- 
tiva." 

IV. Condition of the skin. The skin of a healthy animal 



GENERAL PART OF EXAMINATION. 41 

feels pliable and clastic, and is movable upon its underly- 
ing tissues. If a fold of it be drawn out between the fingers, 
it soon regains its former place when released. 

Where the animal is poorly nourished, out of condition, 
or emaciated from wasting disea.se, the skin feels hard and 
/m/Z/ff /-//XT (.sclerosis, induration). [If the sub-cutis has also 
lost it< elasticity, and the skin adheres closely to the under- 
lying parts, and cannot readily be drawn out in folds, it 
causes a condition that is commonly termed "hide bound- 
ne.ss."] 

In the hide bound animal the epidermis is dry and 
tough, the outer epidermal layer becomes Ioo.se and may be 
easily removed. 

The skin is thus coated with a thick layer of .scales and 
the hair filled with dandruff. 

The exhalations of th e skin sometimes have a 
penetrating urinous odor, noted not infrequently from bladder 
rupture, the contents of the organ being poured into the ab- 
dominal cavity. In the ox nrcthral calculi commonly cause 
this condition. 

V. Swellings in, and immediately under, the skin. Diflfu.se or 
multiple swellings appearing in or immediately under the skin 
are of great importance as an aid to the diagnosis of internal 
diseases which they accompany. 

Tumefactions of the skin attend the following morbid 
processes: 

OE d e m a of the skin and sub-cutis ( ana- 
sarca) is an abnormal accumulation of serum in the connective 
tissue. It is produced by a transudation of fluid (liquor san- 
guinis) from the blood into the intercellular spaces. The lymph 
spaces being clogged prevents the escape of the fluid. 
Qidematous swellings are doughy on palpation, retain finger 
imprints, and those of a non-inflammatory character are cold 
and painless. 

CEdema can be due to: 

a. continued venous congestion, the free circulation of the 



42 CLINICAL DIAGNOSTICS. 

blood being interrupted (dropsy from stasis). In such cases 
a dropsical swelling appears in pendent portions of the body, 
removed from the heart. The prepuce, in front of the mam- 
mae, ventrally along abdomen and thorax, hind limbs, brisket 
and throat are the favorite seats of these enlargements. Any 
morbid condition which interferes with the free flow of the 
blood through the veins, leading to a stagnation in these 
vessels, tends always to produce edematous swellings. They 
attend organic heart troubles, chronic pleuritis, pericarditis, 
and traumatic pericarditis of the ox. 

b. a watery condition of the blood (hydrsemia) with 
which occurs an abnormal porosity of the blood vessels. 
Dropsies due to hydraemia are noted in sheep afflicted with 
animal parasites, [the lung and stomach worms, Str. contor- 
tus, Str. filaria; liver flukes, Dist. hepaticum, being the most 
common]. Leucaemia and anaemia are frequently attended 
with skin dropsies. 

c. inflammatory cedema. (collateral oedema) also produces 
swellings of the skin, but as this is usually local, it is mostly 
of surgical interest. In one form of anthrax appears a circum- 
scribed, hot, hard, painful tumor on the neck, head, or body 
— the malignant carbuncle. A local, hot, edematous swelling 
often betraj^s the presence of deep-lying inflammation — pus, and 
is therefore important in diagnosis. In strangles of horses 
suppuration in unavailable lymph glands is determined by the 
accompanying cedema of the skin in the region of the throat ; in 
glanders it occurs about the farcy bud; in traumatic per- 
itonitis a hot, doughy swelling appears in thehypochondrium. 

In some of the infectious diseases a more or less diffuse, or 
a multiple inflammatory oedema, becomes manifest : in influen- 
za of the horse the eyelids, scrotum and limbs swell; in purpura 
hemorrhagica multiple, later diffuse tumefactions occur on the. 
head, prepuce, lower abdomen, and limbs. Leg swellings in 
purpura are characterized by their abrupt bolster-like, 
termination. 

Emphysema of the skin. EJmphysema of the 



GENERAL PART OF EXAMINATION. 43 

skin signifies the presence of air in the subcutaneous 
tissue. Such swellings crackle on palpation and are usually 
well defined. The contained air can be temporarily displaced 
by applying pressure to parts of the swelling, but as soon as 
the pressure is released the space caused by it refills. 

Emphysema originating spontaneously is infrequent. It 
is mostly due to the formation of gas in decomposing blood 
extravasates or retained abscesses. Spontaneous emphysema 
is pathognomonic of symptomatic anthrax, black leg, where 
it appears upon the back, neck, and muscular portions of 
the legs. 

Emphysema occurs most frequently from the inspiration 
of air from without into the subcutis. The air may enter 
through a wound in the skin, or may come from some air- 
containing internal organ. In the first case the air is sucked 
or pumped into the subcutis through skin wounds which con- 
tinually shift position during locomotion. Wounds in the 
neighborhood of the elbow, therefore, produce emphysema of 
the shoulder and neck. [It is a common practice to treat 
atrophies of superficial muscles ("sweeny") by inflating the 
overlying skin with air artificially introduced by a bicycle 
pump or pipe stem.] In the second case the emphysema of 
the skin has its origin from an internal organ, usually the 
lung, the alveoli of which are ruptured. The course followed 
by the air is as follows: It passes from the ruptured alveoli 
into the subpleural connective tissue, making its way to the 
mediastinum, between which folds it continues to the upper 
part of the thorax, then following the course of the trachea, 
large blood vessels and oesophagus, it escapes from the pectoral 
cavity through its anterior aperture into the subcutaneous and 
intermuscular tissues. Rupture of the pulmonary alveoli may 
result from a destruction of the lung tissue by pus or putre- 
faction (gangrene). Rib fractures involving the lung, great 
intra-thoracic pressure from violent coughing, continued bel- 
lowing, forced contractions (straining) of the abdominal 
muscles in bowel, bladder and uterine troubles, maj- be at the 
bottom of emphysema of the integument. 



44 CLINICAL DIAGNOSTICS. 

Sometimes after rumenotomj- or trocaring, gas passes 
from the paunch through the muscular wound into the sub- 
cutaneous tissue. The skin wound having shifted position, 
the escape of gas to the surface is prevented, hence it collects 
in the loose connective tissue along the back. 



Diseases of the Skin. 

The following terms are most commonly emplo5-ed to denominate the 
phenomena of skin lesions : 

1. Spots, are well circumscribed abnormal colorations of the skin. 

2. Papules are small cutaneous elevations of solid consistency vary 
ing in size from that of a pin head to that of a small pea. 

3. Vesicles are elevations of the outer epidermal laj-er due to the 
accumulation of fluid beneath. They var}- from the size of a millet-seed 
to that of a pea. 

4. Bullae, (small blisters) are large vesicles. 

5. Pustules, are vesicles containing pus, and are therefore colored- 
yellow. 

6. Ulcers, are suppurating wound surfaces which result from necro- 
sis of tissue. 

7. Scales (squamae), are epidermic lamellae which have become 
detached from the skin's surface. 

8. Scabs, or crusts, are dried masses of exudate upon the surface of 
the integument. 

9. Hives, (urticaria, nettle rash), are due to swellings of the pap- 
illar}' bodies, producing well defined evanescent rounded elevations, re- 
sembling welts raised by a whip. 



I. Non-parasitic Skin Diseases. 

1. Alopecia (baldness) is a loss of hair due to some disturbance in the 
skin's nutrition. It may not be attended b}- lesion. 

2. Blood sweating (hematidro.'^is) is the spontaneous appearance of 
blood upon the apparently intact surface of the integume^it. It is pecu- 
liar to Hungarian horses. 

3. Prurigo is a papular eruption accompanied b}- intense itching. 
Biting and rubbing induce additional lesions. 



GENERAL PART OF EXAMINATION. 



45 



4. Summer surfeit (papulo-vesicular-eczema) is a nodular eruption 
occurring usually over the neck and shoulders, leading to a loss of hair. 
[It is seen mostly during the hot months. This condition is often erro- 
neously attributed to some "disorder of the blood." Its chief cause is 
neglect of proper grooming and care of the skin of horses.] 

5. Fagopyrism is an acute, diflfuse, itchy inflammation of the non- 
pigmented skin of the head, due to grazing on growing buckwheat in 
bright sunshine. Brain symptoms sometimes complicate the disease. 

6. Eczema. In a general way the term eczema designates an exuda- 
tive dermatitis. It has much in common with the catarrhs of mucous 
membranes, and like the latter can pass through the varied stages of 
erythema with desquamation, papule, vesicle and pustule formation and 
finally squamms. It is very common in dogs, appearing along the back. 

7. Foot eczema, produced by potato residue, swill and brewer grain 
feeding, is a vesicular eczema occurring on the hind legs of the ox. 
The vesicles rupture soon after formation and their contents dry 
to thick yellow scabs. The hair of the affected parts stands erect 
and part of it falls out. In most instances the eczema reaches no higher 
up the legs than the hock, but may spread to the body or involve the 
anterior limbs. 



II. Skin Diseases Due to Animal Parasites. 

The conmion skin parasites are : 

1. Lice or Pcdiculidae (Hsematopinus asini, eurystemus, urius, etc.) 

2. Bird lice or Mallophaga (Trichodectesequi, scalaria, etc.)* 

3. Louse flies or Hippoboscidae { Hippobosca equina, Melophagus ovis). 

4. Ticks or Ixodidx ( Boophilus bovis) Texas cattle tick. 

5. Fleas or Siphonaptera ( Ceratopsyllus serraticeps of dog, Pulex erri- 
tans of man ) . 

6. Bird ticks or Gamasida ( Dennanyssus avium, D. gallinae) . 

7. Mites or Acarina ( Chorioptes symbiotes, horse, ox. goat, etc.) 

(Psoroptes communis, horse, ox, sheep, etc.) (Sarcoptes equi, canis, 

suis, cati, etc.) (Sarcoptes mutans of fowl), (Acarus folliculorum or 

Demodex folliculorum, var. canis, suis, etc.) 

r*The common hen louse. Menopon pallidum, is remotely relf ed to the trlcho- 
dectes! and resembles them in general appearance. It is said to pass readily to 
other species of birds and to trouble horses kept near lousy henroosts..] 



46 



CLINICAL DIAGNOSTICS. 





Fig. 9. 

Haeinatophiiis egui. 
Blood-sucking Louse. 



Fig. 10. 

Trichodedes eqtii. 
Scale-eating Louse. 



Mange is a contagious dermatitis due to mites. The principal manges are: 




Fig. n. 

Symbiotes bovis. 
Ventral side 



Fig. 12. 

Psoroptes commimis. 
Ventral surface, Egg in Oviduct. 



GENERAL PART OF EXAMINATION. 



47 



Symbiotes mange (foot mange): Favorite seats; in the horse the 



hind ankles, in the ox the tail root 



Fig. 13. 




Sarcoptes scabiei. 
Ventral side. 



These mites live on the skin, pro- 
duce loss of hair, desquamation of 
epithelium, and intense pruritis, 
causing the animal to stamp and 
kick continually. The mites are 
o, 3 — o. 5mm, head broad. The 
legs which are long, are provided 
at their ends with bell • shaped 
suckers. 

b. Psoroptic mange. Seen in the 
horse, sheep and ox. Character- 
ized by great desqua- pig. 14. 
mation,the appearance 
of vesicles and papules, 
the hair or wool being 
agglutinated by crusts 
of dried exudate; wool 
becomes flaky, falls out 
in patches, intense 
pruritis. Thepsoroptes 
is the largest mange 
mite.being 0,4-0, 7mm 
long, head long, point- 
ed, the three - jointed 
legs provided with tu- 
lip-shaped suckers. 



Acarus 
folliculoium. 



c. Sarcoptes mange. Seen in horse, dog, swine and cat. etc. This 
mite burrows tunnels in the cutis, causes nodules, crust formation, thick- 
ening and folding of the skin, pruritis. "Most difficult mite to capture 
for microscopical examination; to obtain material for examination the 
skin should be scraped to bleeding. Sarcoptes are very small, turtle- 
like mites measuring o, 2-0, 5mm, head horse-shoe shaped, legs short 
and stumpy. 

d. Sarcoptic mange of fowls ( Dermatoryctes mutans). It affects the 
legs causing "Scaly Feet." The. lower, naked portions of the legs be- 
comes coated with calcarious, smeary or honey-like, scaly, thick deposits. 

e. Acarus mange. Most conmion in dogs, appearing principally on 
the eyelids, head, extremities, causing little itching. Skin covered with 
scales, small pustules, and is thickened and folded. The parasite is 
vermiform, o, 2-0. 3mm, with a long, narrow, jointed body, the anterior 
portion carrying four pairs of short, three-jointed feet, at the end of each 
a pointed hook. 



48 



CLINICAL DIAGNOSTICS. 



.Ill 



Skin Diseases Due to Plant Parasites. 



Ringworm (Herpes tonsurans) is induced by the fungus Tricho- 
phyten tonsurans. The disease is characterized by the appearance of 
small, round, well defined hairless patches. 
The smooth skin is covered with grey colored, 
asbestos-like crusts. Spontaneous healing be- 
gins in the center of the lesion, extending to- 
ward the periphery ("ringworm"). Vesicles 
rarely appear. Most common in the ox. In 
the crusts and more especially in the hair 
follicles great numbers of round or ovoid, light- 
refracting spores can be seen with the aid of 
the microscope. The spores measure 4,f/. Some 
of the spores are arranged in regular order 
like a string of beads, others are disposed in ir- 
regular groups. The filaments, which may be 
simple or jointed, show little tendency to 
branching; their free ends are rounded. 

Favus. Rare, but appears in fowls as so 

called "white comb" (Tinea galli). Small ^ . , 

, .^. , , ., „, , . , Trichophyton tonsurans, 

whitish-grey spots come upon the comb which ^ ■' 

gradually is encrusted by them. In mammals *• ^air, b. Hair follicle c. 
. . , , , ,, • , , , Spores, d. Single mycella 

thick, depressed, yellowish brown crusts ap- ^^^ conidia. 

pear. 




IV. 



Acute Exanthema s. 



1. Foot and mouth disease [said not to occur in the United States], is 
an acute infectious disease of cloven-hoofed animals, characterized by 
the appearance of vesicles upon the mucous membrane of the mouth, 
the skin of the coronet, and in the interdigital space. Period of incuba- 
tion I to 3 days. The disease is attended by moderate fever, salivation, 
diminished appetite* lameness, recumbent position. The vesicles rup- 
ture, leaving erosions on the mucous membranes, and dry scabs on the 
skin. Complications are not infrequent. Prognosis generally good. 

2. Sheep pox is a contagious exanthema running an acute course and 
having a typical character. Incubation 4 to 7 days; artificial inoculation 
shorter. On the haired portions of the body, around the eyes, nose, 
mouth, inner surfaces of the legs, appear punctiform reddenings (pim- 
ples), later papules. In about six days the papules are covered by ves- 
icles filled with a clear, tenacious fluid (eruptive stage). In the next 



GENERAL PART OF EXAMINATION. 



49 



few days the contents of the vesic'es become turbid, forming pustules 
(suppurative stage); then drying of the pustules to a solid crust ( exsic- 
■cative stage). When the crusts fall off a small depressed cicatrix (pit) 

Fig. 16 




( riicaria. 



remains. During the eruption there is fever, loss of appetite, etc. 
Course about 3 weeks. Mortality 10 to 50 %, 

3. Canadian horse pox. A contagious pustulous exanthema limited 
usually to the saddle and harness rests. Period of incubation 2 to 3 davs. 
A few isolated prominences of the size of a half dollar appear, the hair 
on them is erect and gathered into tufts. The contents of the bullae be- 
comes purulent, erupts, dries to a brownish-yellow solid crust. Caused 
by a bacillus measuring 2fi, which admits of staining with fuchsin. 

4. Urticaria (nettle rash) is a per-acute exanthema which is charac- 
terized by its sudden appearance. Tumefacto is from the size of a pepper- 
corn to that of a hand or saucer come upon the neck, head, inner sur- 
face of the hind limbs and on the body. They are prominent, flat, soft, 
warm, the hair upon them standing erect; itching is rare. 



50 CLINICAL DIAGNOSTICS. 

V. General Diseases which Affect the Skin. 

I. Purpura hemorrhagica (morbus maculosus) is an acute infectious-- 
disease (an intoxication) characterized by the appearance in the various, 
organs of the body, of multiple hemorrhagic centers of varied size. In 
the absence of complications, the disease is unattended by fever. On. 
the mucous membranes of the nasal passages blood spots are seen, more- 
rarely they occur in the conjunctiva and buccal mucous membranes. In. 
the skin and subcutis of the lips, cheeks, and nostrils, appear hard, in- 
flammatory, cedematous swellings from the size of a pigeon's egg to that 
of a hand (larger by confluence) , causing the head of the horse afflicted' 
to resemble that of a hippopotamus. The extremities also swell, the 
swellings terminating abruptly at the stifle and the elbow. There is a 
diffuse cedema of the lower abdomen ; hemorrhage in the internal organs. 
Breathing is labored and stentorious from the mechanical obstruction, 
(swelling) to the entrance of air into the upper respiratory passages. 
There is difficulty in deglutition, colic symptoms, and impaired locomo- 
tion. When the disease has existed for several days, the temperature in- 
creases. Course atypical, 6 to 21 days. Mortality about 50%. 

VL Acute Infectious Diseases which Affect the 

S kin. 

1. Black leg (symptomatic anthrax) is an acute infectious disease- 
caused by the entrance of a germ through a lesion in the skin, a peculiar- 
emphysema resulting. On the body, shoulder, neck, upper portions of 
the extremities (never below the knee or hock) appear swellings whick 
are at first hot and painful, but later co^d, painless, emphysematous. 
Incision causes a foamy, fetid fluid to flow out of them. Attending 
symptoms are high fever, great depression, lameness, dyspnoea. Mor- 
tality is high. [Prophylaxis, protective inoculation]. 

The bacilli of black leg are contained in the discharges from the 
swellings. They measure 3-5// long, o, 5-0, 6/z broad. One end or the 
middle is enlarged to receive an ovoid spore which it bears. May be 
stained by Gram's method. 

2. Malignant oedema (of Koch) appears under the same symptoms as- 
black leg; the swellings are more cedematous than emphysematous. 

The bacillus of malignant oedema is somewhat like the bacillus of 
anthrax, 3-3, 5/< long and i, i/z broad. They are mostly united at their 
ends to form long threads. In the middle of some of the bacilli or at the- 
ends occur spindle or drumstick-like enlargements to receive the ovoid 
spore. The spore does not accept ordinary stains. 

3. Bovine pest (Rind-und Wilder-seuche) is produced by th^ bac- 



GENERAL PART OF EXAMINATION. 



51 



teriuni of hemorrhagic septiciemia and appears in the exanthematous, 
pectoral, or intestinal forms. On the head and neck appear large in- 
flammatory edematous swellings.which spread to the mucous membranes 
of the mouth and throat. The pectoral form is attended by a croupous- 
hemorrhagic pneumonia with pleuritis, and the intestinal form with 
hemorrhagic enteritis and swelling of the intestinal viscera. The 
Bacterium septicemiae hemorrhagicae, like that of contagious pneumonia 
of swine and of chicken cholera, is o, 6// long, o, 3// broad, oval, stains 
only at the ends, an unstained belt remaining. 

4. Examination of the Conjunctiva. 

The examination of the conjunctiva serves to determine 
the quantity and condition of the circulating blood. 

Fig. 17. 




Method. Avoid all rough and hasty manipulations. Before grasping 
the eyelid gain the animal's confidence by arranging the foretop and 
gently stroking the forehead. The right eyelid should be lifted with the 
fingers of the left hand, the left one with those of the right hand. By 
means of the thumb the upper eyelid is raised, the index finger then re- 



52 CLINICAL DIAGNOSTICS. 

. places the thumb, then by gently pressing the everted lid inwardly, the 
mucous membrane of the upper eyelid and the membrana nictitans be- 
come visible. The thumb, which is now free, draws the lower lid down- 
ward. The other three lingers may be rested against the zygomatic arch, 
steadying the hand. (See figure 17). 

In the ox a good view of the scleral conjunctiva may be obtained by 
simply taking hold of a horn and the nose, and drawing the head to one 
side. 

If we wish to arrive at the condition of the blood from an examina- 
tion of the mucous membrane of the eye, that organ must be free from 
local irritation. Severe exercise, high atmospheric temperature cause a 
healthy mucous membrane to appear ver}- red from physiological con- 
gestion; local inflammation also produces congestion. 

A careful comparison of both eyes will enable us to determine the 
presence of local inflammation. In healthy animals the eolor of the con- 
junctiva is pale-roseate; in the ox paler than in other animals. A few 
blood vessels are always visible. In the conjunctiva, the boundary be- 
tween normal and diseased conditions is not sharply drawn, hence prac- 
tice alone makes one capable of giving a reliable judgment. 

I. Color. The color of the conjunctiva is due to the quan- 
tity of blood circulating in the blood vessels of the organ and 
the amount of hemoglobin contained in the blood corpuscles. 
A pale, anaemic color shows that the animal is either deficient 
in blood or that the blood does not contain its normal quota of 
red corpuscles. The color varies from reddish-white to grey- 
ish-white or while. 

Paleness occurs suddenly : 

1. following great loss of blood, internal hemorrhages 
(liver, heart, large blood vessels etc.) 

2. in congestion of blood in the intestines (embolism of 
intestinal arteries, displacement or torsions of the bowels) . 

Paleness appears as a chronic condition : 

3. in constitutional diseases of the blood making organs 
(leucaemia). 

4. in all chronic diseases which lead to anaemia or 
hydrsemia, glanders, tuberculosis, distomatosis (liver flukes) 



GENERAL PART OF EXAMINATION. 53 

parasitic diseases of the stomach and lungs of sheep. 

Abnortnal redness (congestion). When not due to pleth- 
ora, a dark red discoloration assumes the following forms : dif- 
fuse, raniiform, or spotted and brick red, dark red to muddy 
(cyanotic). 

An abnormal red coloration of the conjunctiva is seen: 

1. in congestion of blood in the head (congestion of the 
brain, inflammation of the brain,) the blood vessels can be 
observed appearing prominently in the diffusely red mucous 
membrane. 

2. where the free flowing back of the venous blood 
from the head is impaired, leading to a great distention of the 
veins: heart diseases, weak heart, pulmonarj' emphysema. 

A diffuse, faded bluish-red discoloration of the conjunc- 
tiva is found in conditions leading to an overcharging of the 
blood with CO2. It is seen in feverish diseases (infectious 
diseases), and wherever air is prevented from passing freely 
into the lungs: diseases of the respiratory tract, respiratory 
muscles, or heart. 

Inflammation of the mucous membrane of the gastro- 
intestinal tract in the course of colic, produces a cyanotic con- 
junctiva; if fever appears it becomes ramiform (a bad sign). 

Yellow (icteric) discoloration is best observed on 
the scleral conjunctiva. It is not noticeable by artificial light. 
If the conjunctiva is pale (bloodless), the yellow can be more 
readily appreciated. The shades vary from a mere trace of 
yellow to pronounced lemon yellow; in most cases combined 
with congestion. The icteric discoloration is due to the 
abnormal amount of bile coloring matter found free in the 
blood serum. 

According to the origin of the yellow coloring matter we 
distinguish: 

Hematogenic icterus — originates from a dissolution of the red blood 
corpuscles, the coloring matter which is set free, remaining in the serum. 
Hematoidin and Bilirubin come from the hemoglobin. In contagious 



54 CLINICAL DIAGNOSTICS. 

pleuro-pneumonia of the horse, influenza, azoturia, and in pyemia icteric 
mucous membranes are seen. 

Hepatogenic icterus — a stagnation of the bile in the gall ducts from 
occlusion of the same (icterus of absorption), or from a swelling at the 
opening of the ductus choledochus preventing the flowing out of bile 
into the duodenum (icterus of stasis) can produce hepatic jaundice. 

Icterus is most commonly due to an occlusion of the 
ductus choledochus. Tumors (carcinoma in dogs) may com- 
press the gall ducts, and toxic substances can so act upon the 
liver as to cause icterus. 

Hepatogenic icterus is characterized by the absence of bile 
pigments in the feces (which are of light color,) and their 
appearance in the urine. Severe icterus (icterus gravis) is 
associated with mental depression and slow pulse. 

II. Moistness of the conjunctiva. When the conjunctiva is 
abnormally moist the membrane assumes a peculiar glistening 
appearance; in febrile diseases and in severe colics the mem- 
brane is comparatively dry. 

III. Hen^orrha^es. Hemorrhages appearing in the con- 
junctiva during the course of internal diseases are only 
punctiform when the blood has escaped into the tissue through 
small ruptures in the vessel walls (hemorrhage per hexin). 
These foci are punctiform, spotted, (petechia, ecchymosis). 
Seen in purpura hemorrhagica, severe septicaemia, or pyaemia; 
great anaemia, pernicious anaemia. 

IV. Swelling. Swellings of the conjunctiva usually are 
diffuse and may occur in both eyes. They are due to a 
serous infiltration of the mucosa and sub-mucosa. If of 
an inflammatory character they are hot and painful. This 
condition finds its best development in influenza of the horse, 
the greatly swollen, glassy mucous membrane protruding from 
between the half closed lids. It is seen in contagious pleuro- 
pneumonia of the horse, malignant head catarrh of the ox, 
bovine pest, anthrax, dog distemper, chicken cholera. 

A non-inflammatory swelling of the conjunctiva is seen in 
anaemia, cachectic diseases of sheep ; from liver flukes, lung 
and stomach worms. 



GENERAL PART OF EXAMINATION. 00 

In the course of chronic diseases of the stomach and in- 
testines a slight swelling of the conjunctiva, attended with a 
washed-muddy discoloration, appears. 

V. Discharge from eyelids, Although mostl}' due to local 
diseases, some of the infectious diseases have discharges 
from the eyelids constantly present. The discharge is 
either bilateral (from both sides) or unilateral ( from 
one side only). Bilateral discharges are seen in: ma- 
lignant head catarrh (with keratitis), bovine pest (no 
keratitis present), dog distemper, fowl cholera, iufluenza, 
(Swelling shuts off the tear ducts.) Unilateral discharges 
occur: in continued chronic nasal catarrh, a symptom of 
glanders, chronic nasal or sinus catarrh. [In all animals 
showing unilateral discharge from the eyelids, especially when 
the discharge is copious, a careful examination for foreign 
bodies should be made.] 



5. Bodily Temperature. 

The internal temperature of the body is maintained, with 
slight variation, at a definite elevation by means of an es- 
pecial regulating apparatus. The production of heat in the 
body and the loss of heat from the body are kept equal. If 
the temperature varies from the normal, and this variation be 
preserved for a time, a disturbance due to disease is affecting 
the regulatory apparatus. 

The determination of the internal temperature is of great 
importance in the diagnosis of disease, for each deviation from 
the normal is to be considered a symptom of considerable 
moment. In all diseases affecting internal organs, the meas- 
uring of the temperature is imperative. 

Method of examination. Formerly the temperature was 
approximated by laying the hand upon different parts of the 
bodv, namely the nose, ears, horns, extremities, or by insert- 
ing the fingers into the mouth. Such methods require 
long practice before a reliable estimate can be obtained, 



56 CLINICAL DIAGNOSTICS. 

and they are always deceptive. Only in exceptional cases are 
they now in vogue. The temperature is most accurately 
measured with a thermometer, graduated in degrees and 
tenths of a degree. [Except in America, England and perhaps 
one other country the Celsius (centigrade) thermometer is in 
common use. It is graduated into loo degrees, and these sub- 
divided into tenths of a degree. In this country the Fahren- 
heit thermometer is generally u-ed. It is graduated into 212 
degrees, each degree being subdivided into fifths. Our prefer- 
ence for this latter instrument is largely traditional, and it is 
being displaced by the centigrade, which is now almost 
universally employed in scientific work. 

The following simple formula will indicate how readily 
the Celsius scale may be converted into the Fahrenheit scale 
and vice versa: 

Fahrenheit=9-5 C+32. 
Celsius=5-9 (F— 32).] 

For veterinary practice a maximum thermometer should 
be used, preferably a tested or compared instrument. The 
thermometer should be inserted full length into the rectum, 
which gives the best results, though in exceptional cases the 
vagina is chosen. 

We should, of course, guard against being kicked by the 
animal, and exercise care that the instrument does not break 
and injure the mucous membrane. Before introducing the 
thermometer, the column of mercury should be shaken down. 
The use of water, saliva or oil facilitates insertion. We 
should allow the instrument to remain in the rectum from 
three to five minutes. 

Taking the bodily temperature once daily is of great 
value during the course of an internal disease; in important 
cases the temperature should be registered twice a day (8 a. m. 
and 5 P. M.). After diagnostic inoculations (tuberculin, 
mallein), especially during the critical period, the temperature 
should be recorded at least every two hours. Thermometry 
is of great diagnostic importance during an outbreak of an in- 
fectious disease, the elevation in temperature being often the 
first symptom shown. By taking the temperature 
once daily (best at e ven ing ), t he inf ecte d a n i- 



GENERAL PART OF EXAMINATION. 57 

mals may be determined before further symp- 
toms of disease develop; [influenza, contagious 
pleuro-pneumonia, swine plague or hog cholera, 
Texas fever]. 

I. The Normal Temperature. The normal temperatures of the 
different animals are as follows: 

horse 37-5—38.5° C. ( 99,5—101,3° F.) 

ox. 38,0 — 39,0° " (100,4—102,2° " ) 

sheep 39,0 — 40,5°" (102,2 — 104,9° " ) 

goat 39.0—40,5° " (102,2—104,9° " ) 

hog 38,0 — 40,0° " (100,4 — 104,0° " ) 

dog 37,5—39.0° " ( 99,5—102,2° " ) 

fowls 41,5 — 42,5°" (106,7 — 108,5° " ) 

The temperature will vary a few tenths of a degree in the 
same species, and slight variations may occur in one and the 
same animal within a single day. This latter variation may 
amount to i°C. (1.8° F. ). When the organs (muscles, 
glands) are active a slight rise in temperature takes place, 
when at rest a slight sinking follows. High atmospheric 
temperatures or warm stables, inasmuch as they cause a 
diminishment of radiation, tend to accelerate the temperature. 
As a rule the temperature is lower in the morning than toward 
evening. 

II. Fever. Although the character of fever is not 
expressed entirely by elevation of temperature, we have 
become accustomed to associate high temperature and fever, 
using the terms as if synonymous. As a matter of fact, the 
increased temperature is only one of the characteristic and 
most readily available symptoms of the complex phenomenon 
called Fever. As a rule, however, there is a direct relation- 
ship existing between the height of the temperature and the 
degree of development of the fever. At times in the ox, the 
increase of temperature, as measured by the thermometer, 
fails to correspond with the degree of fever, which can be ap- 
preciated by the remaining symptoms. 



58 CLINICAL DIAGNOSTICS. 

Besides mere increase in temperature, the following phe" 
nomena attend fever: 

1. Chill. When the temperature of the body rises very 
rapidly the peculiar symptoms of chill are shown: pronounced 
trembling of the muscles, which can shake the whole body, 
arched back, erect hair coat, cold skin. Chill is not a con- 
stant symptom of fever, occurring only in certain infectious 
diseases, such as anthrax, septicemia, malignant head catarrh. 
It is further seen in animals reacting to tuberculin or mallein. 

2. Acceleration of the pulse and respirations take place 
more slowly than the increase in temperature; and they do 
not~bear the same relationship to the temperature in all feveis. 
The higher the pulse frequency, the more serious the fever, 
the pulse becoming weak and the artery soft. 

3. Loss of Appetite and impaired digestion. In fever 
the secretion of the digestive juices is lessened, peristalsis sup- 
pressed, (constipation), thirst increased. 

4. Nervous depression. 

5. Albuminjiria. 

III. High Normal Temperature. Although the variations in the 
normal temperature of a given animal are confined to nar- 
row limits, when the temperature exceeds these limits we are 
not always justified in assuming the presence of fever. 
The physiological functions of the oigans can momeriiarily 
become sufficiently accelerated to produce a degree of tem- 
perature in excess of the usual normal one. The appearance 
of concomitant symptoms or repeated recording of the tem- 
perature will generally decide whether fever be present or not. 
In doubtful cases we speak of high normal temperature. 

The following temperatures may be safely assumed to 
indicate fever: 

In the horse a temperature of 39.0'^ 

In the ox " 40. o'^ 

In the dog " 39-2^ 

In the ox and dog fever is often present without a rise of 



(102.2° 


F 


•) 


and 


over, 


(104.9° 


F. 


) 


' 


I 


(102.5° 


F. 


) 


( 


' 



J 



GENERAL PART OF EXAMINATION. 59 

temperature. In such cases we must depend upon the surface 
temperature and the other symptoms of fever present. 

Generally the height of the temperature expresses the 
height of the fever. Four degrees of fever are distinguished, 
which for the horse and dog are as follows: 

1. ;;/z7rf/t'zrr 38.5°— 39-5° C. (101.3°— 103. 1° F.). 

2. moderate fever 39.5°— 40.5° C. (103.1° — 104.9° F-)- 

3. ///>// /^7rr 40.5°- 41.5° C. (104.9°— 106.7° F-)- 

4 . very high fever or hyperpyretic temperature 
41.5" C. (106.7^^ F.) and over. 

Usually in the horse even in the most severe infectious 
diseases, the temperature does not exceed 41.7' C. (107,0- 
F.); only exceptionally, in tetanus, contagious pleuro-pneu- 
monia, and influenza, is this high mark passed. The highest 
temperature is carried by fowls, namely 43,5 C. (110,3° F-)- 
[Incases of "heat stroke" in horses an hyperpyretic tem- 
perature may reach 110,0° F. See also note on swine 
temperature] . 

During a single day a feverish temperature does not 
remain constant, but agreeing with the variations of the nor- 
mal temperature, is lower in the morning than toward evening 
— the so-called morning remissioyis and evening exacerbatioyis. 

Recording of the variations in temperature which occur 
during the course of a disease is also of great importance. 
If the temperature is measured at a certain time daily and 
the record expressed in a graphic manner, the so-called fever 
curve is obtained. From the fever cur\-e is recognized the 
type of fever present. 

In veterinary medicine the following types of fever are 
important: 

1. eon tinned fever, daily variation less than 1° C. 

(i4-5°F-). 

2. remittent fever, daily variation over 1° C. 

3. intermittent fever, periodical temporary fall to normal 
temperature. 



60 CLINICAL DIAGNOSTICS. 

4. atypical fever is one having no regular character. 
In the course of most infectious diseases, three stages are 
distinguished, according to the course of the fever, viz.: 

1. stage of hicreasing temperature (stadium incrementi). 

2. acme, temperature at its highest, (fastigium). 

3. stage of falling temperature , (stadium decrementi). 

A rapid fall of temperature (within 1-2 days) is called 
crisis, a gradual decline, lysis. 

According to duration we distinguish: ephemeral (one 
day), acute and chronic fevers. 

IV. Subnormal temperature. Like the high normal, the 
subnormal temperature may be physiological. Further, it 
may come from the fact that the sphincter ani is relaxed, 
or that the thermometer has not been inserted deep enough, 
or that the rectum is filled with feces, or that defecation 
takes place just before or during the insertion of the in- 
strument. 

A sub-normal temperature due to disease is uncommon. 
It is seen to occur, but not constantly, in parturient paralysis, 
certain gastro-intestinal diseases of the dog, anaemia, hemor- 
rhage, icterus gravis. A subnormal tempera;ture is most fre- 
quent in fatal diseases just before death (temperature of col- 
lapse). 

V. Temperature of the skin. The thinner and more vas- 
cular the integument and the finer the hair coat, the warmer 
the organ feels. Exposed surfaces of the skin feel cooler than 
more protected, covered parts. The ears and extremities, there- 
fore are normally colder than the rest of the body. 

The surface temperature is measured by laying our hands 
upon the skin. During fever the distribution of the bodily 
heat is often irregular, therefore it is not uncommon to find one 
leg cold while its fellow may be abnormally hot; in fever in 
the ox, the horns are sometimes hot and cold alternately. The 
taking of the surface temperature is only of value in the ox 
and dog, the use of the thermometer being more reliable in 
the other animals. 



GENERAL PART (>F EXAMINATON. 



61 



18. 



The temperature of the skin is elevated in fever and after 
exercise; it is diminished usually when the internal tempera- 
ture sinks as in parturient paralysis, collapse. In the chfll 
stage of fever the skin also feels cold. 

General Infectious Diseases. 

Septicemia. Nearly all forms of so called "Blood Poisonings" are 
designated by the collective term, Septicemia. Symptoms: suddenly 
appearing fever, often accompanied by chill; fever of the continued type; 
mucous membranes highlj' reddened, often icteric, frequently ecchy- 
mosed. Very rapid, small pulse. Food and drink refused; fetid diar- 
rhcEa. Great mental depression, blank countenance, eyes sunken. 
Acute or per-acute course- 

Pyemia is a general disease due to pus cocci gaining access to the 
blood, and is characterized by multiple, secondary abscess forma- 
tion (pyemic meta.stasis) in the various organs, lungs, liver, kidneys, 
brain, joints, etc. Diagnosis is easy when primary abscess is available; 
otherwise it is difficult. As each new ab.scess forms the temperature 
increases, therefore it is fever of intermittent type. Mucous membranes 
are congested, icteric. Pulse is continued high. Course subacute. 

Anthrax is an acute infectious disease due to the Bacillus anthracis. 
Begins suddenlv with high fever; tendency toward hemorrhages from 
mucous membranes. In the ox and sheep the course is often apoplectic; 
when course is acute it lasts 1-3 days. Brain symptoms, convulsive 
twitchings of mus- 
cles, rapid pulse, 
dyspnoea, loss of milk, 
are symptoms some- 
times seen. In horse, 
colic symptoms occur. 
Formation of anthiax '*"*' 
carbuncle in skin is d 
not rare in the horse. 
In hog, symptoms of 
severe laryngo-pharyu- 
gitis with swelling pre 
dominate. Diagnosis 
is positive only after 
finding bacilli under 
the microscope. An 
anthrax slide is made 
as follows: A thin 
layer of blood or spleen l 

pulp is smeared over 

a slide, passed three Anthrax bacilli Stained according to Olt's method, 

times through the a. b., Cadaver bacilli. 

flames of a Bunsen burner, then covered with a 2 ^ watery solution of 
safranin and allowed to boil by holding over a Bunsen flame for a few 
moments. Wash and examine. 

The anthrax bacilli are from i to 2 times as 1 o ng as the diameter of 
a red blood corpuscle, and are composed of from 2 to 8 bacterial cells, 
which are stained reddish brown on the slide. Each bacterial cell is 



Fig. 
a 



■n ip .,,mmirtri,. 




62 CLINICAL DIAGNOSTICS. 

cylindrical, slightly longer than broad, appearing almost square in form. 
The ends are plane or somewhat convex. The bacterial cells are sur- 
rounded by a gelatinous capsule, which is stained yellow in the prepara- 
tion, and which joins the cells together to form the bacillus. The capsule 
is bounded by a dark line. If the bacilli come in contact with one 
another they unite, their capsules blending together. 

Influenza. An acute, infectious disease of the horse, very easily trans- 
mitted. Period of incubation 5 to 7 days. First symptom is a rise in 
temperature which continues 3 to 6 days, then crisis. Great debility, 
slow gait, staggering, great mental depression, head held down or rested 
on manger, eyelids and conjunctiva swollen, hot, painful, photophobia. 
Pulse at first strong, little affected, later accelerated. Loss of appetite, 
diarrhoea in about 3 days. In later stages cold, painless, cedematous 
swelling of the extremities. Mortality 4 %. 

Swine Plague and Hog Cholera. Infectious diseases of swine, caused by 
bacilli which enter the body through the respiratory tract (swine plague 
of Smith), or via respiratory tract or mouth — with food and water — (hog 
cholera of Smith ). Period of incubation 4 to 21 days. Young pigs most 
predisposed. One attack produces immunity in most cases. Symptorns : 
apoplectic form; die very suddenly or after a few hours illness (begin- 
ning of an outbreak). Usual form : fever, temperature io7°-io8°F., ap- 
petite impaired, tremblings of muscles, unwillingness to move, stupid, 
dull, hide in litter. Bowels at first constipated; later diarrhoea. Eyelids 
filled with mucus. Respiration accelerated, labored; painful, frequent 
cough. On pendent parts of body skin is reddened, congested; eczema- 
tous eruptions, ulceration of skin. Rapid loss of flesh, unsteady, totter- 
ing gait. Death within 48 hours to 2 weeks. Mortality 20-100^. 

Texas Fever. An infectious blood disease of the ox caused by a proto- 
zoon (Pyrosoma bigeminum) which enters and destroys the red blood 
corpuscles. The disease is sjiread by the cattle tick, Boophilus bovis, the 
younger generation of which carries the protozoon. Period of incuba- 
tion 13-90 days after exposure to tick-infected places. Symptoms : fever ( 104- 
io9°F ), unnatural recumbent positions and standing attitudes; animal is 
dull, stupid; in some cases shows vicious tendencies; horns, ears, and 
hoofs are hot. Pulse is rapid; dyspnoea; constipation, excreta tinged 
with bile. Visible mucous membranes icteric. In later stages urine red. 
Ticks of various size to be found on escutcheon, inside of thighs, base of 
udder or scrotum. Little blood flows from intentional wouads. Charac- 
teristic post mortem changes. Duration 3 days to several weeks. Mor- 
tality 20-90^. 

Fowl Cholera. Period of incubation i day. Apoplectic death com- 
mon. Great exhaustion, staggering, foamy mucus discharged from bill, 
dyspnoea with respiratory sounds, loss of appetite, diarrhoea, bacilli as in 
Wild-und Rinder-seuche (wild and cattle plague). 



. B. The Special Part of the Examination. 

6. Circulatory Apparatus. 

An examination of the circulatory apparatus is of impor- 
tance not onh- to diagnose those maladies which affect the 
organs carrying the blood, but also from the fact that all 
general or infectious diseases of a serious character influence 
more or less greatly the circulation. 

A methodical examination of the organs carrying the blood 
includes: 

I. taking the pulse. 

II. noting the condition of the peri- 
pheral blood vessels. 

III. examining the heart. 

I. Pulse. 

The pulse is felt with the fingers, which may be gently rested upon 
any of the superficial arteries having bone or other hard tissue under 
them. In the horse and ox the sub-maxillary artery is most commonly 
used, in the latter animal the artery is easily felt on the lateral side of the 
jaw bone. Other arteries which may be used to take the pulse are the 
radial, plantar, temporal, transverse facial, and coccvgeal. In the dog, 
sheep, goat, and cat the femoral artery is most available. In dogs and 
cats the brachial artery can be felt on the medial surface of the humerus, 
just in front of and above the elbow. In the hog and fowl the pulse can 
not usually be felt, hence the heart's beat is used. 

a. The Normal Pulse, From a clinical standpoint the i) 
frequency, 2) rhythm, and 3) quality, are of importance to con- 
sider in examining the pulse. 

I.) Normal frequency. By the f req ue ncy of the 
pulse we mean the number of blood-waves (beats) felt in a min- 
ute's time. There is a great variation in the normal frequency, 



04 CLINICAL DIAGNOSTICS. 

not only in the different species of animals, but also in animals 
of the same kind. Many physiological conditions have great 
influence upon the pulse-frequency: size, age, sex, race, at- 
mospheric temperature, time of day, prehension or digestion of 
food, exercise, excitement, are all factors. 

lyarge animals carry a slower (less frequent) pulse than 
small ones; adults slower than young; females higher (more 
frequent) than males; well bred individuals, quicker than 
mongrels; in summer the pulse is higher than in winter; in 
the morning slow^er than toward evening; excited animals 
show a more rapid pulse than animals standing at perfect rest. 
In nervous animals (horses and dogs) the act of taking the 
pulse often increases its frequency. 

Taking these physiological variations into consideration, 
the following is the average pulse-frequency for the different 
animals. 

1. horses 28 — 40. 

colts, two weeks old — 100. 

" four weeks old — 70. 

" six to twelve months old 45 — 60. 

" two to three years old 40 — 50. 

2. asses and mules 45 — 50. 

3. bovines 40 — 80. 

4. sheep and goats 70 — 90. 

5. swine 60 — 100. 

6. dogs 60 — 120. 

7. cats no- 130. 

8. fowls 120 — 160. 

2. ) Normal rhythm. B}- the rhythm of the pulse we 
mean that the individual pulse-beats are separated by intervals 
of equal duration. In large animals, at perfect rest, the pulse 
is usually rhythmic, but in small animals, especially dogs and 
swine, an arhythmic pulse is not exceptional. In mules and 
asses it is also often arhythmic. 

3.) Quality. The individual pulse-waves should be of 
equal volume, i. e., the beats should be of uniform fullness, 



SPECIAL CLINICAL EXAMINATION. 



Co 



alike (puis, aequalis). Depending upon whether the quayitity 
of blood circulating in the arteries is great or small, we distin- 
guish a /«/3,^d' pulse (puis, niagnus) and a 5;/m// pulse (puis, 
parvus), or the artery is spoken of as/«// or eynpty. Accord- 
to Wv^ force of the beat a stro7ig and a weak pulse is distinguish- 
ed. If the artery is tense, the pulse is hard (puis, durus) ; if 
relaxed, soft (puis, mollis). 



Fi,i<. 19 




Normal pulse of horse. 

The pulse quality varies in the different animals ; the nor- 
mal volume, force and hardness can be better appreciated 
through long practice. In the horse the pulse is full, strong 
and the artery is not very tense. In the ox the pulse is small- 
er, not so strong, the artery tense, feeling to the finger, under 
which it rolls, like a rubber tube. In small animals the pulse 
is rapid, strong and hard; in dogs often arhythmic. 

b. Abnormal Pulse. The pulse of an animal suffering, from dis- 
ease will vary from the normal \\\ frequency, rhythm, and quality. 
As far as frequency is concerned the pulse may be too rapid 
(puis, frequens, accelerated pulse), or too sloic (puis, rarus). 

The pulsus rarus is very uncommon. It most often ac- 
companies brain diseases attended by great depression (chronic 
and sub-acute hydrocephalus, tumors in the brain), icterus 

VW. 20 




Slow pulse cf horse. 

gravis, and poisoning from alcohol or lead. In the horse at 
times it is seen in gastro-intestinal affections with loss of appe- 
tite, probably due to some alteration in the sympathetic nerve. 
The pulsus frequens is very common in disease. A very 



66 CLINICAL DIAGNOSTICS. 

rapid pulse, though characteristic of no special disease, is always 
asig7i that the parenchyma of the heart is affected, hence in severe 
diseases it is an index to the heart's strength. Rarely in the 
horse does the pulse frequency exceed 80 beats per minute; if 
it exceed 100, the prognosis is unfavorable. In the ox a pulse 
of 100, and in the dog one of 120-150 denotes severe illness. 
An a bn o r mal 1 y accelerated pulse occurs: 

1. in all severe diseases, especially when attended by 
fever. The frequency of the pulse, however, does not ahvaj-s 
bear the same relationship to the height of the temperature; 
whether the pulse be accelerated or not depends upon the 
fever's affect upon the heart, which differs with the disease 
present. In contagious pleuro-pneumonia of the horse, septi- 
caemia, anthrax, and severe inflammations of the bowels and per- 
itoneum, the pulse rate corresponds to the height of the fever; 
in influenza and in strangles of colts, the acceleration of pulse 
is not marked, compared with the temperature. 

2. in painful conditions (severe injuries, fractures of bones 
abscess in hoof, etc.). 

3. in mental excitement (fear, anxiety). 

4. in severe hemorrhage. 

Abnormal rhythm. When the rhythm of the pulse 
becomes abnormal the pulse is either irregular or intermittent. 

The abnormal irregular pulse is due to lack of innervation 
of the heart, as well as to exhaustion of the organ. If the 
pulse of the horse exceeds 90 it is usually irregular. Irregu- 
larity is also observed in valvular diseases of the heart, and in 
myocarditis. 

The pulse is intermittent when a beat fails now and then. 
When regularly intermittetit, a certain beat can not be felt, as 
for instance, every fourth or fifth pulse wave; when irregularly 
intermittent there is a lapse of pulse which does not occur be- 
tween any certain beats. Sometimes the heart's beat is syn- 
chronous with the intermittency of the pulse; at other times 
the heart's beat is normal, the intermittency occurring only in 



SPECIAL CLINICAL EXAMINATION. 07 

the peripheral vessels. To determine this the radial pulse 
and heart's beat can be compared. 

The intermittent pulse is commonly physiological, and seen 
in perfectly healthy horses and dogs, where it disappears after 
exercise. Pathologically it appears in chronic hydrocephalus 
("dummies"), severe gastric troubles, and during convales- 
cence from infectious diseases which have occasioned high 
pulse (contagious pleuro-pneumonia of the horse). 

Quality. The quality of the pul.se will vary normally. 
The force and volume of the pulse is materially affected in dis- 
ease, the sma//, evipty pulse being a common abnormality. De- 
pending upon the degree of weakness and volume, many 
special types of pulse are distinguished. If the beat is so weak 
as to cause simply a vibration to pass through the empty-feel- 
ing arterial walls, we speak of a trembling pulse {puis, tremu' 
his). When the pulse is very weak and the artery feels empty, 
a thread-like pulse {puis. Jiliformis) is present. In very severe 
fatal diseases the beat cannot be felt, and the pulse spoken of as 
impereeptible {puis, insensibilis). 

The tonus of the pulse is due to the force of the heart's 
action and the tension of the arterial walls. The pulse is hard 
— can not be suppressed easily by the finger— in acute brain 
diseases, tetanus, and great pain. If the pulse is hard and 
small we .speak of it as -wiry, characteristic of inflammations of 
serous membranes, and seen in severe colics, tetatnis, and 
chronic nephrites attended with hypertrophy of the heart. 

The pulse is inequal when the pulse waves are not of 

Fig. 21 




Irregular and inequal pulse of horse. 

equal size, small waves occurring in the intervals between lar- 
ger ones. An inequal pulse is an important symptom of the 



08 CLINICAL DIAGNOSTICS. 

heart's weakness and is iisualh' combined with irregularity; 
it is further noted in valvufar diseases of the heart. 

When the pulse wave is very short, the sudden expansion 
of the artery being followed by an equally- swift contraction of 
the same, we speak of a "jumping" or quick pulse {puis. 
celer)\ if the pulse wave is long-drawn-out, we speak of the 
''tardy pulse {puis, tardus). The hopping pulse is seen in a 
degree of cardiac hypertrophy (left heart). An insufficiency 
(defect) of the semi-lunar valves sometimes develops an ex- 
quisite jumping pulse, part of the great volume of blood forced 
into the aorta by the hypertrophic left ventrical, regurgitating. 
It is remarkable that a jumping pulse ma}- attend heart's 
weakness; it is the result of short spasm-like contractions of 
the heart; the pulse is weak and the artery empty. The pul- 
sus tardus is characteristic of stenosis of the aorta and is a 
small pulse. 

Fig. 22 

Dicrotic pulse of horse. 

The dicrotie pulse is characterized by small beats following 
larger ones, forming a double pulse wave. It comes from a 
diminishment of arterial tomis combined with heart's weak- 
ness; it occurs, therefore, following long continued fever, in 
all forms of anaemia, and is not as well developed in the ani- 
mal as in the human beinor. 



II. Examination of the Peripheral Blood Vessels. 

Arteries. A strong pulse attending wasting disease and ema- 
ciation calls for an examination of the small superficial arteries. 
An abnormally strong />/t/sa//o// in the peripheral arleriesof small 
caliber is visible in the horse in the branchings of the external " 
maxillary artery 

It appears in hypertrophy of the left ventricle especiall>- 
when the bicuspid valves are defective. 

Veins. Tlie state of distention of the veins is of 
primary interest. The veins become prominent after any ac- 
celeration of the heart's action in thin-skinned, fine-haired 
horses; the condition, which is physiological, being a tempo- 
rary one. A permanent distention of the veins is pathological, 
and is due to an obstruction of the free flow of blood to the 
right heart. It is most plainly visible in the jugulars and 
their plexus on the head, other superficial veins (external tho- 
racics, milk veins, veins of the extremities) showing it less on 
account of the oedema usually accompanying the condition. 

The jugulars can be distended to the size of the human 
wrist, or even the arm, appearing as great, round strands. 
The veins of the conjunctiva can also be distended, being re- 
cognized as ramiform, often contorted, bluish strands in the 
mucous membrane. 

The veins are generally distended: 

1. in valvular disease (tricuspid). It is usually sec- 
ondary, but in the ox mostly primary; 

2. in chronic pulmonary diseases interfering with circula- 
tion: emphysema; 

3. in diseases of the heart's muscle, the organ ha\ing be- 
come so weak that it is unable to handle the quantit>of blood: 



70 CLINICAL DIAGNOSTICS. 

traumatic myocarditis of the ox. 

4. from excessive intrathoracic pressure upon the heart 
and large blood vessels: tympanitis, pleuritis, pericarditis 
traumatica of the ox. 

Pulsation in veins. Besides being distended, veins can show 
pulsation under some circumstances. Synchronous with the 
respirations, and independent of the heart's action, a slight 
swelling of the jugulars occurs during the act of expiration, to 
fall again at inspiration. A so called jugular pulse is normal 
in the ox for the following reasons: The jugulars and ante- 
rior vena cava in this animal are comparatively large. The 
continual flow of the venous blood into the right heart suffers 
during the systole of the right auricle, which slightly precedes 
that of the ventricle, a momentary interruption, the blood con- 
gesting in the anterior vena cava and jugulars, causing a- brief 
distention of the jugulars, simulating a pulsation. It is there- 
fore not an active pulsation, but merely a passive undula- 
tion due to a regurgitation of the blood in the form of 
waves. The presystolic appearance of the pulse movement 
characterizes it, therefore it should always be compared with 
the arterial pulse. The collapse of the vein is synchronous 
with the arterial pulse. 

The undulation of the jugular vein is intensified in the ox 
and becomes apparent in other animals when the above cited 
condition prevails, induced by a morbid congestion of the 
blood at the heart. In the horse the venous pulse is seen 
near the aperture of the thorax (lower portion of the neck). 
A true (positive) venous pulse is pathological. It is co- 
incicent with the heart's systole, and is produced by a defect- 
ive closing of the atrio-ventricular valves, the blood regurgi- 
tating into the auricle. True venous pulse is a char- 
acteristic symptom of tri-cuspid insufficiency. 
The valves in the jugulars do not prevent the flowing back of 
the blood, as they are commonly not well developed, and if 
the vein be greatly distended they cannot close the lumen of 
the vessel. 



III. The Heart. 

The heart is examined by palpation, percussion 
and auscultation. 

Anatomical. In all domestic animals the heart lies in the ventral por- 
tion of the thoracic cavity between the third and sixth ribs, in the dog 
extending to the seventh riV). The great mass of the organ (3-5) lies to 
the left of the median line, so that it approaches nearer the left thoracic 
wall than the right one. It does not occupy a perpendicular position, 
but an oblique one directed from the right, in front and above to the left, 
backward and downward, the left side of the ape.v reaching the chest 
wall. 

Horse. The base of the heart lies below the upper half of the height 
of the chest cavity, resting against the thoracic wall, between the 4th 
and 5th intercostal space. The point of contact occupies a surface of 
about 10 cm high and 6-8 cm broad. (See Fig. 25.) 

Ox and small ruminants. The heart is smaller and does not 
extend quite as far back as the 6th rib, its base, however, extends to the 
medial line of the chest. Between the 4-5 ribs it comes in immediate 
contact with the thoracic wall. (See Fig. 26.) 

Dog. The heart is of rounder form and lies very obliquely, touching 
the chest wall along a narrow strip from the 4th to the 7th ribs The 
apex is below the 7th intercostal space. (See Fig. 27.) 

Palpation of the heart's region. The beat of the heart can be felt by lay- 
ing the flat of the hand over the cardiac region. Inasmuch as the acon- 
eus muscles partly cover the region, the hand should be placed between 
them and the chest wall. In the depths a dull thud will be felt, pro- 
duced by the thumping of the heart against the chest wall. The beat is 
due to a contraction of the heart's muscles which causes a slight torsion 
of the organ to the left, bringing the left side, not the apex, in 
contact with the wall of the chest. The beat can best be felt just at the 
5th intercostal space at the union of the ribs to the cartilages of the ster- 
num. The force with which the beat can be felt depends upon the con- 
dition of the animal as to flesh, it being more plainly marked in thin 
animals, and just after severe exercise or excitement. Only in the dog 
can the heart's beat be felt normally on the right side. 

The force of the heart's beat can be increased or 
diminished. When the force of the beat is much increased a 
palpitation of the heart is spoken of. It occurs : 

1. in hypertrophy of the heart (here combined witli 
strong pulse). 

2. in heart's weakness, the muscles of the organ tuuler- 



72 CLINICAL DIAGNOSTICS. 

going spasm-like contractions incapable of properly propelling 
the blood to the periphery, the pulse being small. The con- 
dition is seen in acute myocarditis, endocarditis and pericarditis. 

3. where the lung between the heart and the chest wall 
becomes thickened. 

The heart's beat is weakened: 

1 . where the force is enfeebled from degeneration of the 
heart's muscle. 

2. where the heart is crowded away from the chest wall 
by accumulations of exudate in the thoracic cavity (pleuritis, 
pericarditis) or in some cases of pulmonary emphysema. 

Percussion of the heart. Except in very thin animals 
(horses) the percussion of the heart is of no gi'eat value in the 
diagnosis of disease, the reason being that with the percussion 
hammer we are unable to determine the boundaries of the 
organ, the adjacent lung tissue so modifying the sound that 
the going over of the dull sound of the heart' s percussion to the 
full sound of the lung's is a very gradual one. 

Horse. In the horse, under favorable circumstances, in the region of 
the 4th and 5th intercostal space a zone of dullness about the size of a 
hand can be brought out by percussion. Its boundaries, however, are 
generally indefinite. 

Ox Although the chest walls are thinner in this animal, the heart 
is covered more by the lungs than in the horse. 

Dog. A narrow horizontal line of dullness between the 4th and 7th 
ribs can be determined by vigorous percussion. 

The zone of cardiac dullnefss is increased in 
hypertrophy of the heart and where fluids collect in the peri- 
cardium; tumors and thickenings of the lungs also induce it. 

The zone of cardiac dullness is some- 
times decreased from pulmonary emphysema. 

A tympanitic tone on percussion ovej" the cardiac re- 
gion is obtained in traumatic pericarditis of the ox, gases of 
putrefaction accumulating in the pericardium. 

The percussion of the cardiac region causes the animal 
pain in pleuritis and pericarditis. 



SPECIAL CLINICAL EXAMINATION. 73 

The Auscultation of the Heart. 

Method. The auscultation of the heart may be practiced by placinj^ 
the right ear just behind the left elbow, the leg being drawn forward. 
Small animals may be laid upon the table and the phoneidoscope used. 

Physiology. In the cardiac region and in the neighborhood of the 
same, we hear at each action of the heart two tones. One of these tones 
appears at the moment the organ contracts ( systole ), and the second 
tone, which quickly follows the first, at the dilation of the organ (dias- 
tole). The second tone follows so closely the first one that it is difficult 
to differentiate between them, except in animals which carry a pulse be- 
low 60. In animals which have rapid pulse it may be necessary to com- 
pare the pulse at a peripheral artery with the heart's beat. 

The origin of the heart-tones is still subject to dispute, the authori- 
ties not agreeing. 

[The first heart-sound ( the systolic ) is caused by the contracting mus- 
cles of the organ and the closing of the atrio-ventricular valves. The 
second sound is produced by the closing of th« semi-lunar valves.] 

The first sound in our domestic animals is duller, deeper, 
more prolonged and usually louder than the second one, which 
is short, not so deep, well defined (sharper), not so lotid, and 
at times slightly metallic. There is a great variation in the 
sound produced b}- the heart in the different animals, and even 
in animals of the same species, the sounds being in one case 
sharper (more metallic) and in another deeper and duller. The 
thickness of the chest walls is also of influence, in animals with 
well -muscled chests the sounds are seemingly more mtiffled, 
duller. By pronouncing the syllables lub-dub one can mimic 
the sounds of the heart. 

I II I II 

lub dub lub dub ^ 

Change in Heart-Sounds Due to Disease. 

Both sounds arc increased in : 

1. hypertrophy of the heart, the valves remaining intact, 
(idiopathic hypertrophy). 

2. anaemias. 

3. a thickening of the lung tissue aroinul the heart, pro- 
ducing a better conductor of sound. 



74 CLINICAL DIAGNOSTICS. 

The second sound only is increased: 

when the arteries are greatly distended, not infrequently 
the result of a congestion of the pulmonary circulation com- 
bined with hypertrophy of the heart. 

Both sounds are weakeyied when the normal heart becomes 
enfeebled through disease of its parenchyma, or where the 
hypertrophic organ is exhausted. 

Metallic tones occurring during systole are very common in 
anaemic animals. In traumatic pericarditis of the ox, the per- 
icardium containing gas, a loud metallic tone is heard at each 
systole when the heart-muscle is still vigorous. Sometimes 
the sound can be plainly heard the distance of several paces 
from the affected animal. 

A splitting I -— ' — I — — - I or doubling \ —^ — | — w- | of the 
heart sounds, the condition of the circulatory apparatus being 
otherwise uori:jjal, is of no significance. Commonly the first 
sound is preceded by a short tone -| — — |, which is pro- 
duced by the contracting and unusuall)^ well-developed 
auricle. 

Heart bruits. Heart bruits are abnormal sounds 
and are therefore pathological. They are caused by the sound 
producing parts of the organ vibrating, for too long a time- 
Endocardial bruits and pericardial bruits are distinguished. 

a. Endocardial bruits (noises) come from within the 
heart and are closely connected with the heart sounds. We 
can distinguish, therefore, systolic bruits and diastolic bruits, de- 
pending upon whether they occur at the first or second sound. 
If the bruits are produced by anatomical changes of the heart 
itself, they are called organic, otherwise i7io/ga?iic noises. 

The organic ox endocardial heart bruits are caused either 
by a narrowing (stenosis) of the atrio-ventricular or arte- 
rial openings or by alterations on the valves preventing them 
from closing properly (insufficiency). They form most 
valuable symptoms in the diagnosis of heart diseases. 

In stenosis the bruit occurs at the moment the 
blood passes the contracted orifice, the walls of 



SPECIAL CLINICAL EXAMINATION. 7o 

which are set in vibration. If the stenosis involves the atrio- 
ventricular opening the bruit occurs at diastole, if in the arte- 
rial openings, at systole. 

In i n s u f f i c i e n c y the bruit occurs at the mo- 
ment at which the valves should close. In con- 
sequence of their inability to close a regurgitation of the blood 
takes place, which produces a renewed vibration of the valves, 
and gives a bruit. If the insufficiency involves the atrio-ven- 
tricular valves, the bruit occurs at systole; if the semi-lunar 
valves are insuihcient the bruit appears at diastole 

The character of the bruits is varied, they can be buzzing, 
blowing, hissing, humming, sawing, rattling, long or short 
tones Insufficienc}' bruits are generallysofter than th6se due 
to stenosis. Heart bruits are made more pronounced by an 
acceleration of the heart's action, therefore the patient should 

be exercised before examinatoin. 

{ insufficiency 

I of an atrio- 

I ventricular 

Systolic bruits | | are characteristic of { valve. 

1 stenosis o f 

I an arterial 

i opening. 

( stenosis o f 
j an atrio- 
ventricular 
opening, 
insufficiency 
of a semi- 
I lunar valve. 
Although the bruits originate in different parts of the 
heart, the exact point of origin can not be determined l)y 
auscultation. In the horse and dog valvular lesions have their 
.seat most commonly in the left heart, rarely are they primary 
in the right heart. In the ox valvular diseases of the right 
heart are more frequent than of the left one. The atrio- 
ventricular valves are more commonl\- diseased than the semi- 
lunar, 



Diastolic bruits | | are character- 
istic of 



76 " CLINICAL DIAGNOSTICS. 

Contrar}' to the endocardial, organic bruits, the inorganic 
or anaemic bruits occur without that any discernible anatomical 
alteration appears at the orifices or valves of the heart. Inor- 
ganic bruits are systolic, soft, blowing and not constant {acci- 
dental). They tend to disappear and reappear again. Their 
origin is not well understood. They are nearly always noted 
in anaemic animals. 

It is very important to distinguish between or- 
ganic and inorganic heart bruits, but in practice this 
is often very difficult. As a rule, soft, systolic bruits should 
be very carefully estimated. Organic heart bruits are always 
accompanied by hypertrophy and often alteration of pulse, and 
frequently venous congestion. 

b. The pericardial bruits. These bruits do not 
come from within the heart itself, but are extra-cardial. They 
consist in frictional noises due to the pericardium having be- 
come so altered that its surface is no- longer smooth and slip- 
pery, but rough and drj-. The bruits are characterized by 
being scratching, grating ox creaking, frictional tones not in- 
timately related to either systole or diastole. Pericardial noises 
when present, prevent the regular heart sounds from being 
heard. 

A pericardial metallic gurgling or liquid bruit, synchron- 
ous with the heart's beat, occurs in the course of traumatic 
pericarditis when fluid exudate and gas commingle in the per- 
icardum. 

Diseases of the Circulatory Apparatus. 

Acute myocarditis. A diffuse parenchymatous affection of the heart's 
muscle which attends severe infectious diseases. Symptoms : great 
weakness and debility, mucous membranes C3'anotic, high fever, heart's 
beat weak, systolic sound muffled. Pulse very rapid up to 120 in the 
horse; small, weak, arhythmic, unequal, finally imperceptible. Course 
acute or peracute. Mortality high. 

Hypertrophy and dilatation of the heart. Can be present for years without 
visible symptoms occurring. Symptoms: Pulse strong, also heart im- 
pulse, zone of cardiac dullness enlarged on percussion. Later when the 
heart is greatly dilated and the valves can no longer close sufficiently, 
symptoms of bicuspid insufficiency occur: pulse rapid, arhythmic, uneven; 
heart's beat sometimes palpitating, increased dullness on percussion. 



SPECIAL CLINICAL EXA.MINATION. ( I 

Systolic blowing bruit, diastolic sound intact or louder than normal. 
Exercise causes dyspnoea from pulmonary venotis congestion. Termina- 
tion as in chronic valvular disease. Most common heart disease of horse 
and dog. 

Acute Endocarditis. Not very common. Fever, greatly accelerated 
heart's action, irregular pulse, intermittent, very small. Heart sounds 
are at first normal, later systolic bruit. Dyspnoea. General condition 
altered. Prognosis unfavorable. 

Valvular disease, chronic endocarditis. Caused by a chronic valvular en- 
docarditis which leads to an atrophy of the valves (insufficiency) or to a 
narrowing of the orifices (stenosis). Following valvular failure a hyper- 
trophy of the ventricle always takes place; in disease of the semi-lunar 
valves the left ventricle, in defect of the mitral valve a hypertrophy of 
the right ventricle. The hypertrophy of the ventricle, which is com- 
bined with dilatation, is compensatory. 

Bicuspid insufficiency. Mcst common form of heart dis- 
ease in dogs and horses. Pulse small, irregular. Systolic bruit. Dias- 
tolic sound clear, loud. Dyspnoea on exercise. 

Stenosis of the bicuspid valves. Rare when unattended 
with insufficiency; an uncommon lesion compared with insufficiency. 
Pulse small and' very weak. Diastolic and pre-systolic bruits. Great 
dvspnoea. 

Insufficiency of the tricuspid valves. Rarely pri- 
mary in the horse, mostly secondary to diseases involving the left ventri- 
cle, leading to hypertrophy of the right heart. In the ox frequently pri- 
mary'. Systolic bruits, venous congestion, venous pulse. 

Stenosis of the tricuspid valves. Happens only in the 
ox and is then combined with insufficiency. Diastolic bruits, great ve- 
nous congestion, dyspnoea. 

Insufficiency of the aortal-lunar valves. Full, 
strong, hopping pulse, pulsation in peripheral arteries. Diastolic bruit. 
Hvpertroph)- of the left heart. 

Stenosis of the aorta. Mostly combined with insufficiency. 
Harsh systolic bruit. Long-drawn-out, slow, small pulse (28-32 in the 
horse). Hvpertrophy, attacks of vertigo during exercise (work). 

\' a 1 V u 1 a r diseases of the pulmonary artery are very 
rare. 

Termination of all valvular diseases. In chronic 
heart diseases the dilatation of the ventricle is followed by a relative insuf- 
ficiency of the valves. Semi-lunar defects lead to a relative insufficiency 
of bicuspids; bicuspid defects to a relative insufficiency of the tricuspids. 
The special diagnosis of the primary lesion is then very difficult. As se- 
quela, finally, the following symptoms appear: small, irregular pulse, 
systolic and diastolic bruits, congestion of veins, venous pulse, oedemas, 
dyspnoea, albuminuria, dropsy, attacks of vertigo, emaciation and great 
weakness. 

Pericarditis. Mostly a symptom of other diseases. Moderate fever, 
congestion of mucous membranes. Pulse rapid, heart's beat weak or im- 
perceptible, zone of cardiac dullness increased, pericardial (frictional) 
bruits, which disappear when fluid exudate becomes prevalent. The 
pressure of the exudate upon the veins causes congestion in jugulars 
(venous pulse). 

Traumatic pericarditis of the ox. Begins usually with the symptoms of 



78 CLINICAL DIAGNOSTICS. 

an acute indigestion (traumatic inflammation of the stomach and dia- 
phragm) , which may continue for some time. If the pointed foreign 
body is driven forward, which is commonly caused by the expulsive ef- 
forts of the abdominal muscles during the act of parturition, it usually 
reaches the heart. The general condition of the patient is greatly dis- 
turbed, the expression complaining, anxious. The animals stand with 
back arched and held stiffly, do not like to lie down, and when recumbent 
rest continually on the sterniim. When arising they utter complaints. 
Temperature variable, external (surface) temperature never quite nor- 
mal. Pulse rapid, artery tense. Heart beat cannot be felt, zone of cardiac 
dullness increased and tympanitic when gas has accumulated in the per- 
icardium. On auscultation in the earlier stages pericardial frictional 
bruits, heart sounds clear, when much exudate is present weak; systolic 
bruits of a metallic character in consequence of spasm-like contractions of 
the heart. When putrefactive gases are present the heart sounds can be 
so loud and metallic as to be heard at a distance. Jugulars distended, 
pulsating (undulating), oedema of brisket, neck and throat. Course 
chronic notwithstanding severity of the ailment. Prognosis bad. 



7. Respiratory Apparatus. 

The examination of the respiratory tract 
is one of the most important responsibilities 
of the veterinarian, first because it is frequentl}^ sub- 
ject to disease, and secondly from its availabiliy to thorough 
inspection. 

From the complex anatoni}^ of the apparatus, and the value 
to diagnostics of the varied clinical phenomena it manifests in 
disease, a searching examination of the respiratory tract can 
only be made by following a definite system. 

The examination would include attention to the following : 
I. the respirator}^ movements (respira- 
tions) ; 
II. the exhaled air (expirium); 
III. the nasal discharge; 

IV. the nasal mucous membrane and the 

nasal ca^'ities; 

V. the frontal and superior maxillary 

sinuses; 

VI. the intermaxillary space; 
VII. the cough; 



RESPIRATORY APPARATUS. 79 

VIII. the laryngeal region; 

IX. the trachea; 

X. the percussion of the thorax; 

XI. the auscultation of the thorax; 

I. The respiratory movements. The respirations should be 

examined in regard to frequency, manner in which 

produced, and any special sounds originating during the act 

of breathing. These three factors help to determine whether 

dyspnoea be present or not. 

Frequency of respirations. To deterniiiie the number of respiratory 
movements per minute each rise or fall of the flanks or ribs is counted. 
Observing the play of the nostrils is not as certain a method, as these or- 
gans can be voluntarily moved by the animal. In winter the breath can 
be seen appearing as steam at each expiration. The respirations should 
be counted for at least thirty seconds; in restless animals the veterinarian 
should stand quietly near, count several times and take the average ob- 
tained as the respiratory frequency. 

The smaller the animal the greater the ntnnber of respira- 
tions. In one and the same animal the number of respirations 
per minute will \-ary within physiological limits. 

Just after partaking of food, or when the abdomen is very 
full, and especiall}' after exercise, an acceleration of respi- 
rations is a normal consequence. High atmospheric tempera- 
tures also make the breathing more hurried. In adult animals 
standing at perfect rest the following number of respiratory 
movements per minute may be taken as the average normal: 

horse 8-16 

ox 10-30 

sheep and goat 12-20 

swine 10-20 

dogs 10-30 

cats 20-30 

fowls 40-50 

A patliolo_Q;ical increase in the number of respiratory move- 
ments is spoken of as dyspnoea (see this). A decrease in the 
number of respiratory movements is rarely observed. It is 
seen in severe brain affections (hemorrhage, hydrocephalus, 
tumors, poisonings, action of septic substances during the 



80 CLINICAL DIAGNOSTICS. 

course of pulmonary gangrene), also where the anterior air 
passages are occluded (stenosis), which is combined with a 
pronounced inspiratory tone. 

Physiology of respiration. When an animal is at perfect rest, 
the respirations are produced b}- the action of the dia- 
phragm. The contraction of the diaphragm produces a dilatation 
of the thorax. When the organ contracts it flattens and is drawn 
backwardly, the false ribs becoming elevated. Notwithstanding 
that the diaphragm is stretched transversely between 
the thoracic and abdominal cavities, its contrac- 
tion does not cause its points of insertion to ap>- 
j) roach each other, for the reason that the intestines keep it 
continually forward, which produces a draiving anteriorly of the ribs 
rather than to cause them to approach the median line. On account 
of the double articulation of the ribs with the dor- 
sal vertebrae the forward movement of them is ac- 
companied by a rotation. The diaphragm dilates the thorax 
in that it draws the ribs forward and rotates them outward at the same 
time 

The expiration follows the relaxation of the diaphragm, which 
takes place immediately after the inspiration. "The duration of expira- 
tion is longer than that of inspiration; between them in quietly breath- 
ing animals there is a short pause. 

The normal rhythm of the respirations can be pathologic- 
ally altered in that: 

a. the /// spiratory movement lasts too long, the 
free entrance of air being prevented by stenosis of the respira- 
tory passages. 

b. the expiratory ,act lasts too long, the relax- 
ation of the diaphragm not sufficing to a complete expiratory 
movement because the lungs have lost their power of contrac- 
tion (emphysema). 

As the respirations are in a measure controllable by the 
will, which depends upon the cerebrum, excitement or inflam- 
matorj' conditions occasioning either brain irritation or depres- 
sion, at times can bring about marked change in the rhythm 
of respiration. The value of these changes to diagnostics is 
limited. 

The intensity (depth) of the respirations is not 
marked in healthy animals standing at rest. The alae of the 
nostrils are hardl)^ moved, and the ribs but slightly raised. 
The intensity is increased by exercise; if it 



RESPIRATORY APPARATUS. 81 

is augmented and the animal at rest, it denotes disease. 
Horses dilate the nostrils trumpet-like, dogs open the mouth 
(pant) and protrude the tongue. The movements of the ribs 
and flanks are pronounced. The development of the intensity 
agrees with the degree of dyspnoea. 

The intensity is diminished when the pleura, 
ehest wall or diaphragm is diseased. 

The intensity can become asymmetrical 
in that one ^ide of the thorax undergoes a deeper or more 
rapid movement than the other side. Asymmetrical depth of 
respirations is seen in unilateral pneumonias or pleurites. 

When the rhythm and intensity of breathing is normal 
the ribs and abdomen are moved with even regularity, and the 
type of the respirations are spoken of as cost o-abdomi - 
nal. If the respiratory movements are produced principally 
by the auxiliary muscles of breathing, which dilate the thorax, 
the type becomes costal. The costal type is seen to occur 
where air can not pass freely into the thorax or where the dia- 
phragin or adjacent organs are diseased. (Abdominal tumors, 
ascites, tympanitis). 

When the abdominal muscles are more active in producing 
the respiratory movement than the thoracic muscles the type 
of breathing becomes abdominal. The abdominal type 
prevails when painful conditions of the chest wall are present 
and where expiration is difficult, as in pulmonary emphysema 
(heaves). 

Respiratory Sounds. 

The respirations of healthy animals are performed noise- 
lessly. Only occasionally do they voluntarily emit audible 
sounds during the act of breathing. 

Normal noises occurring during breathing. \'ery fat cattle which 
have just finished a feed and ha\e lain down, sometimes ^ro^;/ 
and grunt as if they were sick. When excited suddenlj- by 



82 CLINICAL DIAGNOSTICS. 

perceiving peculiar looking objects, strange persons, unaccus- 
tomed odors etc. , horses and cattle s)iori by violently and nois- 
ily forcing air through the dilated nostrils. Horses of lively 
temperament usually snort when led at the end of the halter. 
Horses blow their noses by causing a forced expiration which 
is accompanied by a vacillating noise. As in man, dust or 
mucus is thus removed from the nasal organs. Fat, rough 
coated dogs />«';//' when the weather is warm even \rhen they 
are at rest. While performing hard work or during forced ex- 
ercise the breathing is rapid and deep; the air passing in and 
out of the dilated nostrils at each in- and expiration produces 
a perceptible />«^/«_^ sound. Spirited horses while being rid- 
den at a'gallop, emit a blowing exspiratory sound every time 
the forefeet come in contact with the ground. 

A yaivn is a long-drawn-out, deep inspiration taken with 
the mouth held zvide open. The inspiratory muscles assist in 
producing it. 

Pathological noises occurring during breathing. When the respir- 
ator};- apparatus is diseased the following pathological 
sounds may occur : 

1. The ichcezing or bloichig sound which is stenotic in 
its character, emanates from the nasal cavities. It is more 
pronounced at inspiration, and results from a narrowing of the 
nasal chambers due to the presence of tumors, swelling of the 
alae of the nostrils, septum or chonchae, enlargements of the 
turbinated bones or fractures of these bones, fractures of the 
nasal bones, or deposits of exudate on the mucous membrane. 
Depending upon the condition of the mucous membrane the 
stenotic sound may be accompanied by either moist or dry rat- 
tling noises. 

2. Snoring takes place when the act of breathing is ef- 
fected through the open mouth, the soft palate undergoing a 
fluttering motion. In swine and dogs it occurs when the 
lumen or the nasal cavities is contracted b}- swelling or thick- 
ening of the mucous membrane. Snoring is also noted in the 
ox when the retro-pharyngeal lymph glands are swollen or 



RESPIRATORY ArPARATUS. 83 

enlarged; further in the course of parturient paresis. Horses 
under chloroform sometimes snore. 

7 Rattlini^ is a stenotic laryngeal sound which occurs 
when the vocal cords are relaxed. It is heard in severe inflam- 
mations of the larynx or of the neighboring pharyngeal mucous 
membrane; phlegmona of the pharynx and cedema of the glot- 

tis. 

, ' • The Mucous Clirlc ' {klahchcnder Nasal ton ) is a pecu- - 

liar metallic, short expiratory sound first described by Diecker- 
hoff It occurs during an inspiratory-expiratory dyspnoea if 
the nasal mucous membrane is very moist. At a forced inspi- 
ration that part of the nasal mucous membrane which unites 
with the skin of the false nostril, is sucked against the opposite 
wall to which it adheres for a moment; when an expiration 
takes place this adhesion is broken, causing a metallic "slap- 
ping" tone to be emitted. This sound is of no sigmficance. 

''s Tne most important pathological re- 
spirator v t o n e is the stenotic laryngeal tone. Normally 
the sound emitted by the larynx is a soft stenotic sound audi- 
ble when the ear is placed over the organ. [It can be imitated 
bv pronouncing the German -ch"]. If the lumen of the lar- 
ynx is contracted, the noise becomes loud. It is most fre- 
quentlv heard in the horse, and is one of the characteristic 
symptoms of roaring. The tone is emitted when the inspira- 
tion is forced [after exercise] and as to character will vary 
from ivhistUn^ to a pronounced hoarse or roaring tone. 

Besides it may be due to a firm swelling of the laryngeal 
mucous membrane (phlegmonous laryngitis, strangles), tumors 
in the larynx or its neighborhood which prevent the free en- 

trance of air. 

6. Loud rattling noises [garglings] are heard when the 
larynx or the trachea contains loose masses of mucus. 

7 Snee-in^ is an explosive expiration through the nose, 
which originates reflexly from irritations to the nasal mucous 
membrane. It is heard in rhinitis (nasal catarrh) or when for- 



84 CLINICAL DIAGNOSTICS. 

eign bodies enter the nasal cavities. Sneezing only occurs in 
the dog, cat, and fowl. 

8. Groaning is heard when a long deep inspiration is fol- 
lowed by an expiration through the partially closed glottis. 
The sound is only audible at expiration. It is noted in all 
painful conditions, especially of the thorax. 

Labored Breathing, Dyspnoea. 

The collective term d }■ s p n o e a is applied 
to essential deviations from the normal in the 
frequency and kind of respiratory movements, 
and the occurrence of accompanying patho- 
logical sounds. Clinically the presence of dyspnoea is 
recognized : 

1. if the respirations are accelerated (altered in 
number), and the increased frequency is not attended with 
change in the method of breathing, shnple dispnoca. 

2. if the respirations are labored (altered in 
quality), though the frequency may be normal, aggra- 
vated dyspnoea . The occurrence of respiratory 
noises always indicates a difficult >- in 
breathing. Depending upon whether the expiration or 
inspiration is difficult, an expiratory or inspiratory dyspnoea is 
distinguished. 

If the breathing is hurried and atthe same time labored, 
the dyspnoea is mixed. 

Depending upon the seat of the obstruction to free respi- 
rations, nasal, laryngeal, tracheal ox pulmonary d3-spnoea may 
be present. 

Physiologically a dyspnoea occurs whenever the blood 
flowing through the respiratory center contains an abnormal 
amount of CO2. Accordingly, anything which increases the 
quantity of CO2 in the tissues, or interferes with the exchange 
of gases in the lungs, can cause a dyspnoea. 

Simple dyspnoea is characterized by the number of 
respirations being increased without the quality of the respira- 



RESPIRATORY APPARATUS. 85 

tions suffering change. In the horse for instance, the number 
of respirations can exceed 120 per minute and be superficial, 
only the nostrils becoming dilated. If, however, the 
respirations are very difficult, it ceases to 
be simple dyspnoea, for the method of breathing be- 
comes more intensive and labored, and the dyspnoea mixed. 
Simple dj'spnoea appears : 

1. in fever; the degree of respiratory frecpienc}- depends 
upon the severity and nature of the disease. 

2. in all conditions which make the respiratory act painful : 
diseases of the pleura, diaphragm, thoracic wall, peritoneum. 

3. where the breatliing surface of the lung is decreased or 
where the organ is prevented from properly expanding: pneu- 
monia, pulmonary tuberculosis, abdominal tympanitis, ascites. 

In diseases of the heart which have a congestion of the 
blood in the lungs as a consequence. 

The inspiratory dyspnoea. If the entrance of air 
into the respirato-ry organs is made difficult, the animal seeks to 
orercome the condition by taking forced inspirations. Not 
only is the diaphragm a c t i v e 1 >• e m p 1 o >• e d , but 
other muscles which a r e n o r ni a 1 1 >• not used 
during inspiration are called into pla>-. 
These nuiscles are : the serratus anticus major; serratus pos- 
ticus, external intercostals, levators costarum, ilio costalis, 
scalenus. The following clinical symptoms 
char a c terize dyspnoea: 

The nostrils are widely distended; dogs, fowls, cattle and 
swine breathe with their viouths open. Dogs sometimes close the 
jaws and breathe through the lateral commissures of the mouth, 
sucking in the cheek at each inspiration. The head and neck 
are extended horizontally, the larynx is retracted, the ribs 
greatly elevated and rolled forward. The forelimbs are spread 
far apart and the elbows turned out .so that the serrati and pec- 
toral muscles can better come into plaw 

If, in aggravated inspiratory dyspnoea, the air eniers the 
lung very slowly, notwith.standing that the ribs are greatly 



86 CLINICAL DIAGNOSTICS. 

elevated, and the thorax is distended to a degree which does 
njot correspond to the quantity of air passing in, a suction pres- 
sure will occur, which can be recognized by a sinking of the 
lower anterior thoracic 2vall — ^particularly of its intercostal spaces. 
Inspiratory dyspnoea is observed: 

1. in a pure form in bilateral paralysis (paraplegia) of the 
larynx and in severe cases of unilateral paralysis of the organ 
(hemiplegia, roaring). It is characterized by the above cited 
inspiratory dyspnoea and the appearance of a stenotic laryn- 
geal bruit. In less severe cases of roaring this symptom can 
only be brought out by exercising the patient. The act of ex- 
piration is performed without difficulty. 

2. in less pure form where a stenosis of the nasal pas- 
sages, pharynx, larynx or trachea exists; the result of inflam- 
matory swellings, tumors etc. 

3. in diseases of the bronchi and pulmonary tissues pre- 
venting the free entrance of a^r into the lung : bronchitis, pul- 
monary cedema, pneumonia. 

4. where the principal respiratory muscle, the diaphragm, 
is inactive : rupture of inflammation, tympanitis. 

Expiratory dyspnoea. This occurs when the 
exit of the air from the lung is made difiicult. In this case 
the expiration ensues not alone passively, but the accessory 
expiratory muscles actively interfere. The 
muscles aiding expiration are : the abdominal muscles (exter- 
nal and internal oblique, straight abdominal muscle), the in- 
ternal intercostals and triangularis. An expiratory dys- 
pnoea is recognized by the following symp- 
toms: The expiration is prolonged and is attended with pro- 
nounced movement of the abdominal walls (^pumping of the 
flanks). At first, a limited sinking of the thoracic walls en- 
sues from a relaxation of the diaphragm, then the abdominal 
muscles become active (contract) and a furrow is formed along 
the course of their insertion to the costal cartilages — the 
so called ''heave line.'"' The passive and active moments of ex- 
piration can be plainly distinguished from each other, so that 



RESPIRATORY APPARATUS 87 

the movement of the flank appears to be a double pumping. 
The back is elevated at expiration and sinks durino^ inspi- 
ration. At the moment of expiration the anus is o^reatly pro- 
truded in expirator)' dyspnoea. When the abdomen is well 
filled, these symptoms appear more prominently. 
Expiratory dyspnoea occurs: 

1. in vesicular and interstitial emphysema. 

2. in chronic bronchitis and peri-bronchitis. 

3. where the lung has adhered to the costal wall. 

A mixed dyspnoea is present when accelerated 
respiratory frequency is combined with difficult inspiration and 
expiration {inspiratory and expiratory dyspnoea^. It is the 
most common form of dyspnoea and attends all severe diseases 
of the respiratory tract (pneumothorax, hydrothorax) and 
also those diseases wdiich have no primary seat but whose 
course is accompanied by a severe intoxication of the blood 
with CO2 —as in many of the infectiousdiseases. 

II. The exhalations (cxpirium). An examination of the air 
breathed out by the lungs is of diagnostic importance in many 
morbid conditions. Normally the air is emitted from the 
nostrils in two odorless currents of equal size. The two de- 
viations from the normal are : 

i) the air ctirrcnts from both nostrils are not of equal 
size. Where one of the currents is smaller (of less volume) 
than the other, it points to a narrowing of the nasal 
passage of that side. Not infrequently a bloicing sound 
accompanies the inspiration. The passage may be constricted 
by thickenings or swellings of the mucous membrane or by 
tumors. 

2) the expiriuni has a bad odor. A bad odor from the 
nostrils is always a sign that putrid decomposition is taking 
place in the air passages. The odor may emanate from different 
parts of the respiratory tract. The odor is either putrid {fetid ) 
or earious. It is ob.served : 

in stagnant masses of putrefying exudate in the nasal 



0» CLINICAL DIAGNOSTICS. 

conclise, sinuses, guttural pouches, or eveu on the mucous 
membrane of the upper air passages and bronchi. 

in putrid decomposition of tumors in the air passages. 

in suppuration or necrosis of the bones of the head bor- 
dering on the air passages: Suppuration in the tooth alveoli, 
dental caries, necrosis of the turbinated bones. 

in gangrene of the lungs. 

It is always important to determine where the odor 
originates. At first we should be clear as to whether it 
really comes from the nose or from the mouth. When the 
mouth is closed, this is usually not difficult; in doubtful cases 
the odor of the saliva can be tested. The safest way is to 
make an examination of the buccal cavity, especially of the 
teeth. When the alveoli of the upper molars are diseased, a 
carious smell is emitted from both the mouth and nose. (See 
Examination of the Mouth). 

If the offensive odor has been found to come from the 
expired air, it is then necessary to locate the part of the 
respiratory apparatus at which the decomposition is taking 
place. For this purpose we should first determine whether or 
not the odor is equally offensive from both nostrils. When 
the odor from one nostril is more prevalent than from the 
other, the process of decomposition has its seat in the nasal 
cavity of that side, and usually it is accompanied by a unilat- 
eral nasal discharge, bulging of the facial bones and swelling 
of the submaxillary lymph glands. 

The examination of the upper molar teeth of that side 
should never be neglected. 

When the odor is equally offensive from either nostril, 
the putrid focus is as a rule contained in the lung, more rarely 
in the pharynx, larynx or trachea. 

Putrid decomposition in the lung is not 
always to be ascribed to pulmonary gan- 
grene, for not infrequently a decomposi- 
tion of exudate in the bronchi, {fetid 
bronchitis) is present. 



RESPIRATORY APPARATUS. 89 

III. Nasal discharge. Only in the ox a slight nasal dis- 
charge is seen to occur in health, which the animal usually 
removes from the nostrils with its tongue. In the other 
animals the appearance of a nasal discharge is always a sign 
of disease, and one of considerable diagnostic importance. It 
can accompany all diseases of the respirator}^ tract which are 
exudative in character, such as catarrhs of the nasal cavities, 
sinuses of the head, throat, larynx, trachea, bronchi and 
lungs. In these cases the discharge is the product of the 
disease. Sometimes the discharge comes from the digestive 
tract, from the mouth or pharynx, more rarely from the gullet 
or stomach, when it contains substances such as food particles, 
water or saliva. 

The character of the nasal discharge depends upon the 
organ from which it comes and the nature of the disease pro- 
ducing it. We should bear in mind that the ox, sheep, goat 
and dog usually lick off the discharge, hence it is not so 
noticeable in these animals as in the horse. 

To correctly jadge nasal discharge the following should 
be considered : 

The quantity, which will varj' great!}-. The discharge is 
slight in catarrhs that are neither very diffuse nor severe. In 
tuberculosis, notwithstanding the severit}- of the case, there is 
little discharge because what little exudate appears upon the 
surface of the mucous membranes is removed by coughing and 
eventually swallowed. 

The discharge is copious in strangles and in diffuse catarrhs 
of the upper air passages and bronchi. 

Unilateral nasal discharge is characteristic of disease of 
one side of the anterior air passages as far back as the fauces. 
A catarrh involving but one side of the soft palate or pharynx 
may also show a discharge from only one nostril. 

Of especial importance is the variation in quantity of the 
discharge. In some cases a copious amount of discharge is 
ejected when the head is suddenly lowered [unreining after a 
drive] , while for a day or more there is present either no dis- 



90 CI.INICAL DIAGNOSTICS. 

charge at all or only a very slight one. This symptom is 
characteristic of catarrhs of the frontal and superior-maxillary 
sinuses and of the guttural pouches. 

The color. The color of the nasal discharge depends upon 
the character of the inflammation, and also the presence of 
foreign mixtures. It will vary from colorless to grey, white, 
yellowy red, brown or green in all their difTerent tints. During 
the course of a disease the color of the nasal discharge will 
change with the character of the inflammation. A serous or 
mucous discharge is usually colorless; a purulent discharge 
is gray or yellow or maybe of a greenish hue. 

A green discharge usually is due to an admixture of the 
chlorophyll of the food, deglutition being difficult. Food 
particles are always present in such cases. In rare instances 
a greenish tinge is seen, due to decomposed blood coloring 
matter being present in the discharge. 

A yellocL', rust-colored discharge is seen in hemorrhagic 
hepatization of the lungs (contagious pleuro-pneumonia of the 
horse). It is due to an admixture of blood coloring matter. 

A bloody discharge is observed only when blood ?« toto is 
present. It may be due to : 

finger-nail injuries to the mucous membrane of the nose 
or fractures of nasal bones. In the dog the presence of Pent- 
astomum taenioides ma}^ lead to blood}^ nasal discharge, and in 
sheep the larvae of oestrus ovis. 

in glanders; bleeding tumors in the nasal cavities. 

Nasal hemorrhages may attend anthrax, purpura hemor- 
rhagica, or very severe cases of contagious pleuro-pneumonia 
of the hor.se. 

The consistency of the nasal discharge depends upon what 
it contains. It ma}" be serous, viucoid or viucila(jinoiis^ 
with varied intermediations. It maj- also be flocculent, 
chivipy, or contain great masses of adhe7'ing exudate. In the 
beginning of a catarrh the discharge is serous (clear), but by 
admixtures of mucus it becomes mucoid, and loses its trans- 
parency from the quality of epithelial cells it contains. Its 



RESPIRATORY APPARATUS. 



91 



color is then gray. When an admixture of pus is present the 
discharge assumes more of a crcam-likc consistency and its 
color changes to gray-yellow or yellow. A discharge of pure 
pus only occurs when an abscess ruptures into the nasal cavity. 

A c 1 u m p y , b u 1 1 e r m i 1 k • 1 i k e discharge is 
observed in chronic catarrh of the sinuses of the head because 
the exudate has been retained for a time. 

Adhering masses of exudate are seen in diph- 
theritic, croupous, or fibrinous inflammations. 

The odor. The odor of the nasal discharge becomes foul, 
putrid or carious from decomposing processes. In such cases 
the expirium is also tainted. For the determination of the seat 
of the order, what has been said concerning the odor of the 
expired air applies. 

Foreign admixtures. Most commonly we observe air bubbles 
of large or small size which cause the discharge to appear as 

foam. 

Fine foam. When the discharge comes from the smaller 
bronchi in pulmonary oedema and bronchitis, the foam is com- 
posed of small air bubbles of equal size. When there is much 
foam the discharge is white in color. Horses suffering from 
chronic bronchial catarrh after exercise show a white nasal 
discharge partially made up of fine foam. 

Coarse foam. This is not infrequently unilateral and con- 
tains an 2.Axo\yi\.\x\toi food particles. It comes from the mouth 
and consists in part of saliva. Coarse foam is symptomatic of 
paralysis of the pharynx, pharyngitis or fungus poisoning. 

When food particles alone make up the nasal dis- 
charge, it is a sign that vomiting has taken place. The dis- 
charge is then not foamy, is of acid reaction and contains no 
admixtures of exudate. 

A microscopical examination of the nasal 
discharge is rarely of practical value. It may sometimes be of 
use to determine the presence of the embryo or egg of Strongy- 
lus filaria in the lungs of sheep or of Pentastomum taenioides 
in the nasal passages of the dog. 



02 CLINICAL DIAGNOSTICS. 

The examination for pathogenic micro- 
organisms yields positive results only in exceptional 
cases. The tubercle bacilli are one of these exceptions as 
their characteristic way of excepting stains serves to identify 
them microscopically. 

Fig- 23. 





V r 


\, 


-'} 


^ 


, 1 


^ 


»-^ 




"^ : r^ 


y 


1( 


r 


\V^ 


^ 


N 


> 


^ '%i' 


f 






> <''•'- 




r\ 


\ 


^ 

\ 




>', 


% 


-^ /^' 




\ 




't ^ 








a* ' 

Tubercle bacilli. 




-' .: 



Microscopical determination of tubercle bacilli. A cover-glass preparation 
is covered with Ziehl's carbolized-fuchsin solution (fuchsin i, absolute 
alcohol 10, carbolic acid 5, aq. dest. 95), and heated repeatedly for about 
two minutes over a flame. Wash and drain. Gabbet's solution (methy- 
len blue 2, in 100 grammes of a 25% sulphuric acid) is then applied and 
allowed to remain )4 minute. Wash and examine. 

IV. The examination of the nose and upper air passages. The 

external appearance of the facial bones will readily betray any 
deformity . Circumscribed enlargements are due to tumors 
and a bulging of the sinuses in chronic catarrhs.. Diffuse en- 
/a?^<?;«^w/j' attend rachitis and osteoporosis, "big head " De- 
pressions have a traumatic origin. Swellings appearing 
at the nasal openings and nostrils are common in purpura 
hemorrhagica. Tumors (atheromas) are frequent in the 
false nostril. 

The specific pathological conditions 
which occur about the lips and nose are the pustules and ulcers 
which attend contagious siomatitis, the pox ptistulcs of sheep 
pox, and the vesicles on the muzzle of the ox and snout of swine 
suffering from foot and mouth disease. 



RESPIRATORY APPARATUS. 



93 



When a nasal discharge has existed for a long time, the 
integument of the nose and lips over which it flows loses its 
pigment. The white streaks thus formed speak for the 
chronicity of the discharge. 

The examination of the nasal mucous membrane. The nasal 
mucous membrane is available to inspection only in the horse. 
Local lesions occurring on it are often of great diagnostic im- 
portance. 

Method of examination. The head of the animal should be elevated 
and the inner cartilaginous wing of the nostril grasped between the 
thumb and middle finger which draws it upward and outward; the ex- 
tended index finger is then inserted under the outer wing, which it dis- 
tends. The patient should face the light, except when the rhinoscope 
(an enlarged opthalmoscope) is used. 

Fig. 24. 




Examination of the Nasal Mucous Membrane. 



DIscolorations. Indistinct, punctifomi , or rami form redness 
is not infrequently seen in acute and chronic catarrhs; they are 
due to the peculiar anastomosing of the capillaries and are of 
no diagnostic value. 

Deep redness is mostly the result of hemorrhages in the 
mucous membrane. They appear mostly punctiform and can 
be as large as a ten cent piece, they are well circumscribed 
and of roimd form (^ petechice, eechynioses). When they become 



94 CLINICAL DIAGNOSTICS. 

confluent, the redness is diffuse or appear^ in irregular streaks. 
P e t e c h i se are most commonly seen in purpura hemor- 
rhagica, but may also occur in anaemia and in leucaemia. 
The spots, which are at first dark red, soon fade and assume a 
brownish hue. Such suffusions are also observed in septicaemic 
diseases: anthrax, septicaemia. 

Swelling of the nasal mucous mem- 
brane is characterized by the normal surface of the mucous 
membrane, which is granular from the many glands it con- 
tains, becoming firm and smooth. As the membrane is usually 
tense, the swelling is not marked. Its origin is inflammation, 
therefore the surface appears turbid. 

Chronic, connective tissue thickenings 
are most commonly made manifest bj^ irregular, wart-like 
prominences which show the characteristics of scars. 

Wounds in the mucous membrane are 
very often caused b}^ finger-nails, sharp straws and the like. 

Nodules from the size of a millet seed to that of a 
peppercorn almost exclusively attend glan- 
ders. Exceptionally they result from contagious stomatitis, 
but in such cases like nodules are to be found in the mucous 
membrane of the mouth. Isolated nodules are seen in follicu- 
lar catarrh, a very rare disease. To prevent mistaking parti- 
cles of mucus for true nodules, the supposed nodule should be 
palpated with the finger; if mucus particles, we can thus wipe 
them off. 

Next to nodules, ulcers form the most 
important criterium in diagnosing glan- 
ders. Glanders ulcers have jagged borders circumscribed by 
rounded, elevated walls. The base of the ulcer is sunken, 
uneven, gray in color, and of lardaceous appearance. The 
favorite seat of the glanders ulcer is on the medial border of 
the inner cartilaginous wing of the nostril, hence this place 
should always be examined. 

In rare cases ulceration of the nasal mucous membrane 
also attends stomatitis and purpura hemorrhagica. For dif- 



RESPIRATORY APPARATUS. 95 

ferentiation the concomitant symptoms must be considered, 
such as ulcers on the buccal mucous membrane, petechiae, etc. 

\'ery superficial pittings with sharp 
borders — not rounded nor red colored — represent the 
catarrhal or erosion ulcer. 

Cicatrices at the lower end of the nasal septum are 
mostly the result of previous wounds. They are often curved 
(( as if made with a finger-nail. Glanders cicatrices are as a 
rule more or less star-shaped. 

The examination of the sinuses of the head is often of importance 
and should be made whenever a chronic nasal discharge exists, 
especially when attended with an unilateral bulging (enlarge* 
ment) of the facial bones. Mere enlargements can be 
defined by palpation. The presence of exudates in the sin- 
uses can sometimes be determined by percussion. The nor- 
mal percussion sound of the sinuses is full, but when they are 
filled it becomes empty. When the s i n u s es are only 
partially filled the percussion sound is not 
changed. Negative results from percussion, therefore, do 
not exclude the presence of exudate. 

V. Examination of the submaxillary lymph glands. Although 
these glands do not properly belong to the respiratory appara- 
tus, the examination of them is significant in the horse. In 
this animal especially, the glands become sympathetically dis- 
eased when pathological conditions exist within the domain of 
their lymph vessels. 

Anatomy. The lymph vessels from the nostrils to the ethmoid bone 
carry their lymph to the sub-maxillary glands, a small glandular packet 
as broad as and a little longer than a finger, lying on each side of the in- 
termaxillary space. They begin at the point where the inferior maxil- 
lary artery passes under the ramus of the lower jaw, and extend forward 
to the angle of the chin where each unites with its fellow of the opposite 
side. Each lobule is of about the size of a small bean. In horses of 
coarse conformation the intermaxillary space is often filled without the 
glands being swollen. 

As soon as an absorption of irritant or 
infectious substances [bacteria] takes 
place in the region drained by the lymph 
vessels of the s u b - m a x i 1 1 a r y g 1 an d s , these 



96 CLINICAL DIAGNOSTICS. 

organs become secondarily diseased. The 
primary disease usuall}- has its seat in the mucous membrane 
of the nasal passages or sinuses. An examination of the 
glands, therefore, is of great significance in determining the 
pathological condition of these mucous membranes. 

In making the examination the following points are to be 
considered : 

Is one or both glands enlarged? In acute 
infectious catarrhs the glandular swelling is generally bilat- 
eral; in glanders frequently unilateral, and in tumors in the 
nasal passages, bad teeth and chronic catarrh of the sinuses, it 
is, as a rule, unilateral. 

Size and form of the glandular swell- 
ing. Many or a few of the lobules may be enlarged to the 
size of a bean, pigeon or hen's ^ZZ^ depending upon the pri- 
mary disease in the mucous membranes. Acute swellings are 
smooth; chronic swellings lobulated (nodular), which is es- 
pecially marked in glanders. 

Consistency of the swollen glands. The 
swelling is soft in serous, tense 2i\\^firni in cellular infiltration of 
the glands. Acute diffuse swellings (strangles) 
leads often to suppuration (abscess), which 
can be determined hy fiuetiiatioyi. In glanders diffuse abscess 
formation never occurs in the glands; only rarely does a small 
purulent focus [farcy bud) appear in the skin over the gland. 
Firm, hard enlargements are always due to some 
chronic irritation and consist of connective tissue proliferations. 
Such attend chronic glanders, catarrhs and dental fistulae. 
Extensive well defined enlargements of the 
individual glandular lobules are observed in leucaemia and 
when malignant tumors are present. 

Temperature and sensitiveness. When 
the glands are hot and tender (inflamed), the morbid con- 
dition is acute (strangles). If the enlargement of the gland 
is firm, cold and painless, it points to glanders, chronic 
catarrh, tumors or hyperplasias [leucaemia] . 



RESPIRATORY APPARATUS. 07 

M o V a b i 1 i t y of the glands. If the irritation 
is chronic and attended with the formation of new connective 
tissue, the process involves the environing tissue, forming ad- 
hesions with its neighborhood. In acute purulent inflammation 
of the glands there develops in the vicinity, namely, directly 
beneath the skin, an inflammato)'y ivdcniatous or, perhaps, a 
p/i/(]Qmo7ioi(s s7ceNiuff. 

The extirpation of a diseased lymph gland is recommended where 
glanders is suspected. Its object is the patho-anatomical or bacterio- 
logical examination of the gland. The operation can be performed on 
the standing animal when local ancssthesia is employed, and is not 
dangerous. 

VI. Cough. Cough is a suddenly occurring 
expiratory- impulse which follows a deep 
inspiration. The glottis is forcibly oi:)ened 
during the act, causing a sound to be 
emitted. By coughing accumulations of mucus are re- 
moved from the bronchi, trachea or larynx. In animals cough 
is a reflex action which can to a certain extent be suppress- 
ed. Although it can be induced by irritation to many peri- 
pheral nerves, as a rule it emanates from branchesof the vagus 
nerve in the respiratory apparatus. Most sensitive in this par- 
ticular is the superior laryngeal nerve of the larynx and the 
first three rings of the trachea. The mucous membrane of the 
trachea is less sensitive, except at the bifurcation of the bron- 
chi. The bronchi are just as easily irritated as the larynx; 
but cough can not be excited from the par- 
enchyma of the lungs. It can, however, emanate 
from the pleura when this organ is in a state of irritation. 
Peripheral irritation is transmitted to the cough-center in the 
brain, which innervates the expiratory muscles and recurrent 
nerve, inducing the reflex spasm called cough. 

In exceptional cases cough can emanate from terminals of 
the vagus nerve lying outside of the respiratory apparatus, as, for in- 
stance, from the external auditory meatus [ear], nose, or abdominal or- 
gans. .\ccirding to .\lbrecht cough can occur from abscess in the liver. 
These are, however, exceptional c (ses. Cough from the stom- 
ach has never been observed in the horse. There is a possibility that 
cough may have its origin in the brain. These exceptions are worthy 



98 CLINICAL DIAGNOSTICS. 

of note and should be considered in those cases of cough the cause of 
which can not be determined to lie in the respiratory apparatus. 

Cough occurs: 

if foreign bodies are inhaled : smoke, dust (dusty food), 

acrid gases (ammonia, sulphurous acid, chlorine etc. J 

if cold air is inhaled, especially if the respiratory tract is 
inflamed : catarrhs of the respiratory mucous membrane, 
pleuritis, traumatic injuries to the pleura (traumatic gastro- 
diaphragmitis of the ox) 

if mucus, exudate or foreign bodies (food) and parasites 
are present in the air passages : Gastrus lavae in the larynx, 
Syugamus trachealis in the wind pipe, Strongyli in the bronchi. 

In no case can cough originate when the sensory ter- 
minals of the vagus nerve are no longer sus- 
ceptible to irritation. In severe phlegmonous dis- 
eases of the mucous membrane, cough is absent. The cough 
center in the brain must also be in normal condition. It is 
disturbed when great mental depression 
exists. Therefore, when appreciable irritations (rales) are 
present, unaccompanied by cough, the prognosis is an unfa- 
vorable one. 

The character of the cough. The character of the cough va- 
ries with the species of animal. Healthy horses have a strong, 
vigorous, loud, full-toned congh.; cattle a sharper defined, softer 
toneless, prolonged cough, the glottis being held open. The 
appearancje of cough in animals is always abnormal; its char- 
acter depends upon the disease which causes it. Whether 
cough accompanies the disease or not can usually be learned 
from the anamnesis, although we can not depend upon this to 
determine its character. It is always best that we induce the 
patient to cough in our presence; this may be done by press- 
ing the hand against the upper three rings of the trachea or 
the finger ends against the arytenoid cartilages of the larynx. 
In sensitive healthy horses one or a few short coughs will fol- 
low the manipulation, while in indolent individuals there is no 



RESPIRATORY APPARATUS. *.*y 

reaction. In the ox coug^hing can only be induced in this way 
when the animal is diseased. 

If the ox can be made to cough by pressing the upper 
trachea or larynx, or if coughing takes place in the horse 
when only slight pressure has been used, some abnormal irri- 
tation exists. If cough can be readily induced by pressing 
the lower windpipe, a tracheitis is present. 

When cough exists the following should be considered 
concerning its character: 

The frequency of the cough. A cough may 
may ho. occasional or frequent, continual ox transitory. If the 
cough is occasional usually only one or a few impulses occur, 
but when frequent several in succession — ay?/ of coiighins;. 

The pain fulness of the cough is cognized by the 
general behavior of the patient which seeks to suppress the 
pain by shaking the head and making masticatory and swal- 
lowing movements. The animal may also be restless, paw 
and groan. A painful, painless, burdensome, and torturing 
cough may be distinguished. The cough is painful in acute 
bronchitis, pleurisy, pleurodynia, and in so called "whooping 
cough" of dogs; painle.ss in chronic laryngitis. 

The force of the cough impulse depends upon 
the vigor of action of the respiratory muscles. Accordingly, 
the cough may be strong, vigorous, or ic'cak. It is weak if ex- 
piration is difficult or if the patient is unable to cough vigor- 
ously : reduced, debilitated animals, pulmonary emphysema, 
bronchitis, hydrothorax; or if the expiration is painful : pleu- 
risy, pneumonia, pleurodynia. The cough is strong if the 
elasticity of the lungs is normal and no pain attends the act. 

The duration of the cough impulse is de- 
termined by the force with which the pulmonary air is held 
repressed by the closed glottis. If the pressure is great, the 
glottis will be suddenly forced open and the cough will be 
short. If the glottis is not completely closed (paralysis of the 
arytenoid cartilage -roaring) or the repression of the air 
causes pain (pleurisy), the cough is long — prolonged. 

L.ofC. 



100 CLINICAL DIAGNOSTICS. 

The depth and magnitude of the cough 
depend partly upon the force and duration of the cough im- 
pulse. The magnitude is influenced by the quantit}' of ex- 
pelled air. We speak of a deep and a shallow cough. 

The cough soundis dependent upon the force of 
the cough impulse, the tension of the vocal cords and the spe- 
cial condition of the surface of the mucous membrane. The 
sound may be loud — loiv, clear, dull: sharp, zchistllno-, dense - 
hollow; loose, moist — dry. 

The "return impulse" of the cough (Hus- 
tenruecktstoss). Each cough is followed by a short, deep in- 
spiration. If the glottis is not fully open at the moment this 
inspiration takes place, the air rushing in causes the partially 
stretched vocal cords to vibrate, causing a harsh, short, laryn 
geal stenotic sound to be emitted. It is heard in paralysis of 
the larynx (paraplegia, hemiplegia) and in severe inflamma- 
tory swelling. 

The act of coughing tends to eject masses of mucus, ex- 
udate etc. from the bronchi, trachea, and larynx. Animals do 
not expectorate because that which is coughed up into 
the throat, as soon as it reaches the pharynx, is swallowed. 
Sometimes, however, a part is discharged through the mouth, 
the lower naso-pharyngeal wall and the soft palate being forced 
forward by the air passing out, which leaves the opening into 
the buccal cavity free. The thus expectorated mass is usually 
mixed with mucus from the pharynx and mouth and also 
with food particles. 

Addendum. Change in voice is of little significance in 
animals. Commonly we observe a hoarse voice in laryngeal 
catarrhs. This is most marked in dogs. In rabies the voice 
suffers change. In dogs affected with this disease the bark is 
prolonged into a long, dismal howl, the voice being at the same 
time hoarse. In horses a short, squealing tone is emitted. 

VII. Examination of the larynx and trachea. Enlargements in 
the region of the larynx are as a rule not confined to this organ, 
but to neighboring tissues as the pharynx, lymph glands, sub- 



RESPIRATOKY APPARATUS. 101 

cutis. When we determine the seat of the enlarg^enients by 
palpation we may at the same time note their temperature, 
sensitiveness, and the ease with which cough can be induced 
by pressing upon them. Where much exudation is found in 
the larynx, infiltration of the vocal cords or other folds of mu- 
cous membrane, a trembling of the organ ma>- be felt {laryti- 
gcal fremitus). 

On auscultation of the larynx or trachea, nor- 
mally a stenotic sound is heard [like a German "ch"]. It is 
due to a vibration of the vocal cords and laryngeal walls which 
is produced by the air forced through the organ. It is heard 
best at expiration. When the mucous membrane of the lar- 
ynx is swollen and firm, this sound becomes very pronounced 
and assumes a 7.7//.?///;/^ or hissing character. If the swelling 
of the laryngeal mucous membrane is loose, or deposits of exu- 
date cover the membrane, the .sound produced is rattling; or 
purring. 

In examining the trachea we should look out for scars 
resulting from tracheotomy wounds. The 
form of the trachea should also be noted. In chronic trachei- 
tis of the ox the trachea may be shaped like a saber scabbard. 
Laryngoscopical examination. With the aid of the laryngoscope in- 
vented by Polansty and vSchindelka. the interior of the larvnx may be 
examined directly. I'or the diagnosis of inflammatory conditions in 
the larynx this examination is of no practical value. However, in paral- 
ysis of the arytenoid cartilages the instrument can be used to advantage. 
[This instrument, which is a modified endoscope, consists of a cylin- 
der 56 cm long and 4,7 cm in diameter, at one end of which is an optical 
illuminating apparatus. The light is furnished by an electric battery, 
and undue heat is prevented by a special cooling arrangement. The in- 
strument is in.serted through the nostrils and can be used in the horse 
without casting.] In left sided paralysis of the larynx ( roaring) the left 
arytenoid cartilage is seen to project farther into the lumen of the larynx 
than the right one. This is plainest to be seen when the larynx is mov- 
ing. As the larynx ot the horse is usually held in the position of "mid- 
dle inspiration," it is necessary to induce forced inspiration and expira- 
tion. To do this the thorax is encircled with a girth which is slowly 
and gently drawn tight and relaxed, alternately, imitating forced breath- 
ing. The larynx in the meantime is watched through the instrument. 
At each inspiration the healthy cartilage is seen to move outwardl} 
while at each expiration it ajjproaches the middle line. The diseasef 
cartilage, on the other hand, either remains completely at rest ( paralysis 
or its movements are very tardily performed (paresis). 



102 



CLINICAL DIAGNOSTICS. 



In bi-lateral paralysis (paraplegia) of the larj-nx as a rule dyspnoea 
is shown when the patient is at re-t, at least if it is at all excited. In 
this case both arytenoids can be seen protruding into the lumen of the 
larynx at each inspiration; at each expiration thev are forced flutteringly 
aside. The paralysis can be complete or incomplete, and is often better 
developed on one side than on the other. 

VIII. Percussion of the Thorax To properly percuss the 
lungs a knowledge of their topographical position is essential. 
Anatomy. The lungs and heart do not occupy the whole of the tho- 
racic space The abdominal viscera encroach upon a greater part of it. 
The partition between the chest and abdominal organs is the diaphragm. 

Fig. 25 




Heart: — 



— Line of Insertion of Diaphragm; — Boundary 
of Lung during Expiration. 



This organ is inserted, in the arc of a circle, to the inner surface of the 
whole thorax, reaching in an oblique direction from the sternum back- 
wardly and upwardly to the lumbar vertebrae. In the region of the ster- 
num itspointsof attachment areat the union of the ribs to their cartilages, 
farther posteriori}', however, the diaphragm does not extend down as 
far as the cartilages of the false ribs, but passes obliquely across their 
inner surfaces until, finally, at the last rib it finds attachment at the 
superior end. The diaphragm arches forward from its points of insertion, 



RESPIRATORY APPARATUS. 



103 



extending into the thoracic cavity in the shape of a cone the apex of 
which reaches in the various animals, somewhat beyond the middle ot 
the 7th or Sth rib. At expiration the diaphragm lies with its muscular 
portion directlv against the lateral chest wall, the tendinous port'on 
then forming the partition. With the beginning contraction of the dia- 
phragm at inspiration the arch becomes flattened in that the organ is .Irawii 
Lav from the inner wall of the chest. The space left by the receding 
diaphragm is immediately occupied by the sharp borders of the lungs 
which then lie close to the points of insertion of the dtaphragm. At the 
acme of inspiration the rounded, cone-like form of the diaphragm be- 
comes more pointed and its base and apex approach each other, the ribs 
having been drawn forward. By this drawing forward of the ribs the 
transverse diameter of the thorax is increased and the base of the cone- 
like diaphragm broadened. (See page 80). 

Accordinglv, the lateral border of the lung is continually moving 
backward and forward, traveling a distance in the larger anima s of 1-2 
hands breadth, and in the smaller ones from -^ to i hands breadth. On 
an average the posterior border of the lung mav be defined by a line 
which in the larger animals is the width of a hand from the points of in- 
sertion of the diaphragm. In small animals the distance is one half t.us. 

Fig. 26 




Heart; —Boundary of Field of Percussion; 
Lupg. _ . _ Insertion of Diaphragm; 



- . . — Boundary of 

— Paunch. 



The availablcness of the lungs for clinical examination. The area 
of percussion is defined dorsa//y by the thick muscles of the 
back. This boundary to percussion, which varies with the 
condition of the animal, is limited by a line drawn from the 



104 



CLINICAL DIAGNOSTICS.. 



posterior angle of the scapula to the external angle of the ilium. 
Anteriorly the boundary is formed by the scapula and the 
massive shoulder muscles. 

By drawing the leg forward the field of percussion can be 
somewhat enlarged. Ventrally the density of the sternum and 
muscles overlying it renders in this region the lungs unavail- 
able to percussion. 

The JieM of poxussion is a right-angled trian- 
gle the right angle of which lies at the base 
of the scapula. In all animals the dorsal and anterior 
boundaries of the field of percussion are the same, the only 
variation being in the abdominal boundary. 

Horse. The abdominal boundary is a line drawn from 
the i6th intercostal space, crossing the middle of the thorax at 
the nth rib, to the olecranon. 



Fig. 27 




Heart, shaded part not covered by Lung; ~~l Field of Percussion of 
Lung; — • — Insertion of Diaphragm; L Liver; M Spleen; 
R Rectum; D Small Intestines. 



Ox. In ruminants the field of percussion is small on ac- 
count of the less number of ribs (13) which causes the dia- 
phragm to lie farther forward. 



RESPIRATORY APPARATUS. 105 

The abdominal boundary in this animal is a line drawn 
from the nth intercostal space, crossing the middle of the 
thorax at the 9th rib, to the olecranon 

Swine. In swine, percussion can rarely be employed, 
as the thick layer of sub-cutaneous fat and the restlessness of 
the animal greatly interfere. The abdominal boundary of the 
field of percussion extends from the nth rib to the olecranon. 

Dog. In the dog- the shoulder lies well forward which 
gives a larger field of percussion. The abdominal boundary of 
the field extends to the 9th rib at the middle of the chest wall. 

The normal pulmonary percussion sound is due to the vibration 
of the thoracic wall, the elastic pulmonary tissue and to the 
air contained in the lungs. 

The intensity of the sound depends upon the 
volume of the air containing lung tissue which is set in vibra- 
tion. It will vary with the force used in percussing, the 
thickness of the chest wall and the volume of the part of the 
lung vibrating. Accordingly, more force is employed in per- 
cussing a thick walled chest than a thin walled one. 

As the normal percussion sound at the 
boundaries of the field of percussion mer- 
ges gradually into a tympanitic or a dull 
sound, the exact borders of the lungs can 
n o t b e d e f i n i t e 1 y d e f i n e d under the hammer. 

In vesicular pulmonary emphysema, interstitial emphy- 
sema (which is rare), and pneumothorax the field of percus- 
sion is somewhat enlarged posteriorly, the diaphragm suffering 
permanent backward displacement. 

An abnormally loud, full sound can be 
heard under normal conditions if the wall of the 
chest is very thin, under such circumstances the vibration of 
the lung being unusually audible. 

Exaggerated pulmonary resonance ocr 
curs: 

I. if tlie lung is much inflated with air (emphysema). 



106 CLINICAL DIAGNOSTICS. 

2. if the lung is abnormally distended with air as it oc- 
curs at the bolder of pleural exudate. 

3. in pneumothorax. 

If the dull or empty percussion sound is heard where the sound 
should be resonant, it always signifies disease It occurs: 

I.) if the lung tissue beomes dense from 

a. pneumonic hepatization: in contagious 
pleuro-pneumonia (Brustseuche) of the horse, and in conta- 
gious pleuro-pneumonia of the ox as a rule a large portion of 
the lung becomes solid and liver-like, and emits, on percus- 
sion, a dull or flat sound. In catarrhal pneumonias the pulmo- 
nary sound is not so flat, because the solidification of the lung 
is not complete, the morbid process appearing in the form of 
more or less isolated centers or foci which are not entirely void 
of air. In hypostatic, metastatic, and ichorose pneumonias, 
swine plague, dog distemper, verminous pneumonia and tuber- 
culosis the percussion sound is not diffusely dulled, but a dull 
sound is emitted over the dense diseased centers only. 

b. chronic interstitial pneumonia combined 
with atelectasis. 

2.) if tumors or neoformations are present 
in the lungs: glanders, tuberculosis, carcinoma, sarcoma, echi- 
nococci, etc. 

3.) if an airless, solid medium come be- 
tween the lung and the plexi meter; 

Inflammation, swelling of the thoracic wall (after mustard 
applications); neoformations on the pleura; collection of con- 
siderable pleuritic exudate or transudate in pleuritis, con- 
tagious pleuro-pneumonia of the horse, contagious pleuro- 
pneumonia of the ox, and in swine plague. In the horse the 
presence of but a few litres of fluid in the chest cannot usu- 
ally be determined. 

Pleuritic dullness is characterized by its horizontal upper 
boundary which shifts if the position of the body is changed, 
the contained fluid seeking the lowest level. This latter is 
most marked in small animals. 



RESPIRATORY APPARATUS. 101 

The tympanitic percussion s o u n d is also abnormal 
when it occurs in the thorax. It appears: 

1 ) in collapse of the pulmonary tissue 
from a retraction of the lungs in the presence cf pleuritic ex- 
udate. The collapsed lung floats upon the exudate, hence 
above the horizontal line of dullness a tympanitic zone exists. 

in the first and last stages (resolution) of pneumonia, 
if numerous, small tumors occur in the lungs and the pul- 
monary tissue amid them is collapsed. 

2) if caverns, or large bronchiectases [mor- 
bid dilatations of the bronchi] are present in the lungs. The 
intensity and clearness of the tympanitic tone depends upon 
whether the cavities momentarily contain air or exudate. 

3) in pneumothorax. 

4) in prolapsus of bowel into the thoracic cav- 
ity through the ruptured diaphragm. 

The tympanitic percussion sound his a metallic tinkling 
tone when the walls of the air-containing cavity are smooth 
and distended. 

The eraeked-pot resonance. [This resembles the sound pro- 
duced by striking the hands, loosely folded across each other, 
against the knee, the contained air being suddenly forced out 
between the fingers — Loomis]. It occurs in the thorax when 
a large air-containing cavern is in direct communication with 
a bronchus. Forcible percussion causes some of the air to be 
suddenly driven out of the cavern into the communicating; 
bronchus, thus inducing this peculiar resonance. The 
cracked-pot resonance, however, does not al- 
ways indicate the presence of a cavern in 
the lung. 

IX. Auscultation of the lungs. In auscultating the thorax: 
over healthy lung, we perceive a soft, sipping sound, the vesic- 
ular or alveolar murmnr. The sound can be imitated by 
softly pronouncing the letter "v". It begins with the inspira- 
tion, increasing as the inspiration continues, and becomes, at 



108 CLINICAL DIAGNOSTICS. 

expiration, a fainter, shorter sound having the character of a 
softly aspirated letter "f". 

The intensity of the murmur depends upon 
the intensity of the respirations. The more forcible and deeper 
the respiratory movements, the louder the vesicular murmur. 
After exercising- the animal it is therefore more distinctly audi- 
ble. As a rule the murmur is softer and less distinct in the 
horse than in the ox. 

Concerning the origin of the vesicular mur- 
mur, it is assumed that the sound is simply a continuation 
of the normal laryngeal stenotic sound which has be- 
come modified in the bronchioli. During inspi- 
ration the sound producing stream of air is directed toward the 
ear, therefore the vesicular respiration is more audible at in- 
spiration than at expiration. 

As with the laryngeal respiratory sound, so are other 
sounds originating in the upper air passages transmitted to the 
lungs. These are rattling throat sounds, wheezing, groaning 
etc. Their appearance in the chest has no diagnostic signifi- 
cance. 

Alterations in the vesicular respiration. An exaggerated vesicu- 
lar respiration occurs : 

if the respirations are intensified, therefore in physiological 
and pathological dyspnoea. 

if it is compensatory; that is, if one portion of the lung is 
required to perform extra work for another portion which is 
diseased and incapable of taking part in the respiratory act. 
[For instance, where one lung does the duty of its fellow 
which is diseased.] 

if a bronchitis is setting in, the lumen of the bronchi 
being contracted by swelling of, or collections of exudate on, 
the mucous membrane. The exaggerated vesicular murmur 
in such cases is a symptom of great diagnostic importance. 

A diniiiiished of feeble vesicular respiration occurs: 

if the thoracic wall is thickened from fat accumulations 
or disease: swelling, neoformations. 



RESPIRATORY APPARATUS. 109 

if the air cannot enter the vesicles in 
consequence of great swelling or plugging of the bronchi: se- 
vere bronchitis. 

if the exchange of gases in the lungs 
is impaired: emphysema, beginning hepatization, and a 
partial compression of the lungs by pleuritic exudate. 

Absence of the vesicular murmur, and no other sounds present 
in the lung [i. e. total absence of any pulmonary sound] occurs: 

if pleural exudates or tumors have displaced the lung tissue: 

rarely in severe vesicular pulmonary emphysema, or a 
complete occlusion of a bronchus preventing access of air into 
certain portion of the lung. 

Jerking, interrupted respit atory sounds are often produced 
by animals voluntarily, from restlessness or fear. In such 
cases it is heard in both lungs. Pathologically it is 
confined to certain portions of a lung, and 
is observed when the free entrance of air into the vesicles is 
made difficult by a contraction or occlusion of the bronchi 
(bronchitis). 

Bronchial respiration. The bronchial respiratory sound is 
normal in the larynx and trachea; its appearance in 
the chest is always a sign of disease. It is 
merely a laryngeal sound which is continued into the bronchi 
and is only audible when the bronchi are free and the vesicles 
contain no air. 

Bronchial respiration displaces vesicular respiration: 

if the vesicles are filled with exudate, therefore in all 
pneumonias, especially in contagious pleuro-pneumonia of the 
horse and in contagious pleuro-pneumonia of the ox. To be 
heard, however, the hepatized portion of the lung must be of 
the size of a double clenched fist and lie next to the costal 
wall. 

if the lungs are compressed by pleuritic exudate (atelec- 
tasis). The compression must be complete, for if the vesicles 
contain air at all a feeble vesicular murmur can still be heard. 

A special variety of bronchial respira- 



110 CLINICAL DIAGNOSTICS. 

t i o n is the amphoric respiration , which is a bruit, of a charac- 
ter like the sound produced by gently blowing across the 
mouth of a narrow necked bottle. In animals it is rare, but 
appears if large caverns in the lung communicate with bronchi 
(pulmonary gangrene). On percussion, in place of 
the dulled sound which is usual when the 
respiration is bronchial, a tympanitic tone 
or a cracked-pot resonance is heard. 

That bronchial respiration may become audible the bronchi 
must not be occluded; if they are filled with masses of 
exudate, no respiratory sound is heard. A forcible cough, 
however, may dislodge and eject the exudate and the bronchi 
become free again. 

The va^ue or indefinite respiratory sounds. Such sounds are 
spoken of when it can not be determined whether they belong 
to the vesicular or bronchial respiration. Either the sound is 
too feeble to be heard easily or other louder sounds drown it. 
Vague respiration is heard if hepatization is setting in, the 
vesicular murmur becoming weak and the bronchial sound 
just beginning. A slight compression of the lungs or partial 
occlusion of the bronchi with exudate may also produce it. 

I^ales or rhonchi. Rales are heard in disease and appear if 
the bronchi or a cavern in the lung contain exudate against 
which air is forced. 

Moist rales appear if the bronchi contain a quantity 
of light, fluid exudation, (bronchitis). The larger the bron- 
chi and the greater the quantity of exudate they contain, the 
larger will be the bubbles which are broken and the 
coarser the rales. In the large bronchi and in cavei'ns, the 
rales may assume z. gurgling or bubbling character. We also^ 
distinguish medium, coarse, and fine rales; the latter origina- 
ting in the bronchioli. Rales may occur irregularly and are 
not always of like intensity. Sibilant rales are heard only at 
inspiration, increasing in intensity as the inspiration progress- 
es; coughing may temporarily remove them. The intensity 



RESPIRATORY APPARATUS. Ill 

of rales depends upon the extent of the disease and the topo- 
graphical position of the diseased part. 

Moist rales originate from the to-aud-fro movement of 
mucus [pus, blood, liquid exudate], the forming and bursting 
of bubbles, and the vibrations produced by these acts. Ac- 
cording to whether rales attend vesicular or bronchial respira- 
tion their tone will vary; metallic rales as a rule accompany 
bronchial respiration. 

B}' crepitant rales, we understand very fine, crackling 
noi.ses, which resemble the sound heard when the ear is rested 
very lightly upon the haired skin of an animal. Taking their 
origin into consideration they can be grouped with neither the 
moist nor the dry rales. They originate from a separation, at 
inspiration, of the adhering walls of the bronchi and vesicles. 
They appear in bronchiolitis, pulmonary cedema and in the 
exudative (catarrhal) stage, and last stage (resolution) of fib- 
rinous pneumonia (contagious pleuro-pneumoniaof the horse). 

Dry rales appear if a small quantity of a tough bron- 
chial secretion is present, or if the mucous membrane is great- 
ly swollen. These conditions produce stenosis of the bronchi, 
hence the sound is stenotic and of a sonorous, hii))unin<y, hiss- 
ing or whistling character. Dry rales most commonly attend 
chronic diseases: chronic bronchitis, compression of the bron- 
chi by nodules (tubercles, chronic pneumonia) and tumors 
(echinoccocci). In the echinoccoccus disease of the ox the rale 
has a peculiar (quurksend) character. 

A wheezing, crackling, whistling or piping, rale- like 
sound is heard in interstitial emphysema of the lungs. It is 
most pronounced during expiration. 

Pleuritic friction sounds. Normally the pulmonary pleura 
plays noiselessly upon the costal pleura during the movements 
of each re.spiratory act. If, however, the pleurce become 
rough and dry from inflammatory deposits upon them, a sound 
is produced at respiration. This sound is best heard where 
the movement of the pleural laminae is greatest, therefore near 
the sharp borders of the lung. The intensity of pleuritic fric- 



112 CLINICAL DIAGNOSTICS. 

tion sounds depends upon the extent of the disease [pleuritis]. 
They are audible as grazing or rubbing sounds just below the 
ear; if there is an intimate adhesion the sound is emitted in a 
series oi Jerking, creaking, or cracklinq noises. 

A pleuritic friction sound appears in 
dry or fibrinous pleuritis only. It is most fre- 
quentl}' heard in contagious pleuro-pneumonia of the horse 
and in contagious pleuro-pneumonia of the ox. It rarely 
occurs from the presence of tumors or neoformations upon the 
pleura. In tuberculosis, as a rule, no friction 
sound is heard. 

Pleuritic friction sounds are easil}^ confused with rales. 
Friction sounds are heard regularly zX inspiration and 
expiration, may sometimes eyen be felt, and occur most fre- 
quently in a series of abrupt, jerking noises upon which cough 
has no influence. Rales are commonly more pronounced at 
inspiration than at expiration, are not jerking in character, 
and are removed or modified by cough. 



Diseases of the Respiratory Apparatus. 

a. Cavities of the Head. 

Acute nasal catarrh. Rhinitis catarrhosa. Congestion of the mucous 
membrancF, serous or mucous, rarely muco-purulent nasal discharge. 
Only when disease is severe is mild fever present; transient swelling of 
the sub-maxillary lymph glands. 

Chronic nasal catarrh. Mostly unilateral. Discharge often muco- 
purulent or light colored and "glassy" in appearance; quantity varies. 
Nasal mucous membrane pale, sometimes catarrhal erosions. Enlarge- 
ment of the sub-maxillary lymph glands. 

Chronic catarrh of the superior maxillary and frontal sinuses. Symptoms 
of unilateral chronic nasal catarrh. When head is lowered discharge 
suddenly increases. Bulging of the diseased siuuse.' ; if filled with exu- 
date empty sound on percussion. 

Tumors in the cavities of the head. Most common are sarcomas in the 
sinuses and polypi in the nasal cavities. Chronic nasal discharge, 
enlargements, wheezing respiratory sounds, sub-maxillary glands also 
diseased. 

Parasites in the cavities of the head. Larvse of Oestrus ovis in the sheep, 
pentastomum taenioides in the dog. Sneezing, nasal discharge, wheezing 
respirations, brain symptoms. 



RESPIRATORY APPARATUS. 



Larynx and Bronchi. 



113 



Acute laryngeal catarrh. Laryngitis acuta. Cough which is at first 
dry and painful, later more moist. When disease is severe : mild fever, 
accelerated pulse, dyspnoea with laryngeal stenotic sound. 

Croupous laryngitis. vSudden fever, sometimes chills. Persistent, hack- 
ing cough. Loud laryngeal stenotic sounds, great inspiratory dyspnoea. 

Oedema of the glottis. Suddenly appearing severe inspiratory dysp- 
noea, loud wheezing or shrieking respiratory noise, head hekl extended. 
Stenotic sound does not disappear by partially closing the nasal openings. 
Per-acute course. , , ■ i • £ * 

Chronc laryngeal catarrh. Cough, especially when the animal is first 
brought out into the air and at work. , - ., i 

Roaring. Hemiplegia laryngis sinistra. An atrophy ol the muscles 
of the larynx due to a paralysis of the inferior laryngeal nerve (recur- 
rent) which causes an inspiratory sound. No fever, no catarrhal symp- 
toms. Prolonged hoarse cough with return sound. Inspiratory sound 
when respirations are forced. Partial closing of the nasal openings causes 

sound to cease. . ■■ i ^ 

Acute paralysis of the larynx. Suddenly appearing severe inspiratory 
dyspnoea, which is apparent when the animal is at rest or slightly ex- 
cited- loud whistling or shrieking respiratory noises, anxiety, restless- 
ness. . Partial closing of the nasal openings diminishes the sound, gen- 
eral condition not disturbed. ■ ^n 

Acute bronchial catarrh. May only be diagnosed when disease is well 
developed. Fever, accelerated pulse, dyspnoea, cough which is at tirst 
dry, later loose. Full sound on percussion. On auscultation, rales which 
depend as to character upon the seat and quantity of the exudate 

Chronic bronchial catarrh. No fever. As a rule a short, dull, weak 
cough. Dyspnoea not pronounced at rest; at work marked. Sometimes 
a fine-foaniv, serous nasal discharge. ^ , 11 „„/i«,- 

Verminous bronchitis. Lungworm plague. Develops slowly under 
svmotomsofbronchialcatarrh with prolific exudation. In mucus: par- 
asite's, eggs, or embryos of Strongylidae. Later, anaemia, cachexia and 
death. 

c. Lungs. 

Pulmonary congestion and pulmonary oedema. Sudden appearance. Se- 
vere mixed dyspnoea up to 100 respirations per minute. Percussion nor- 
mal, auscultation : exaggerated vesicular respirations, crepitant rales, 

'^ ""pleurodynia. This is a congestion of the lungs conibined with severe 
pains in the thoracic walls. General apathy, excessive dilatation o the 
thorax, which is "held.- Groaning. Respirations So per minute, super- 
ficial. Temperature high-normal, pulse accelerated. Super-re.sonant 
sound on percussion, feeble vesicular munnur. „e ^^tarrhal 

Catarrhal pneumonia. Broncho-piieumonia. Begins usually ^s catarrhal 
bronchitis. High, intermittent fever, painful cough. 0"lv when disease 

is extended can pneumonia be aPP'-e^''^t^^lvf"^"'"f^"^,^lS^;esDi 
dullness on percussion; vesicular murmur feeble, rarely bronchial respi- 

'^''^'°Gangrene of the lungs. Fever. Expirium at first of a sickening, sweet- 
ish odor later stinking Discolored grayish-brown, tenacious nasal dis- 



114 CLINICAL DIAGNOSTICS. 

charge. Percussion: tympanitic sound, cracked-pot sound at periphery 
of necrotic centers. Auscultation: large rales, bronchial respiration, 
amphoric sound. Not infrequently combined with pleuritis. 

Alveolar emphysema. May only be diagnosed when well developed. 
Expiratory dyspnoea with "double-pumping" of the flanks, protrusion of 
the anus. Cough, short, dull, weak. Super-resonant percussion-sound, 
iield of percussion enlarged posteriorly. Auscultation shows the vesicu- 
lar murmur to be diminished. 

Interstitial pulmonary emphysema. Suddenly appearing mixed dyspnoea. 
Cough very superficial or absent. Super-resonant percussion sound with 
tympanitic accessory sound extended posteriorly. A peeping sound in 
auscultation. Emphysema of the skin frequent. 

Echinococcus disease. Ox. Diagnosis is only possible when large num- 
Ijers of the echinococcus bladders are in the lungs. No fever. Dyspnoea. 
Cough weak and blowing. Percussion dulled in patches or tympanitic. 
Vesicular respirations diminished. 

d. Pleura. 

Pleurisy. Pleuritis. Fever depending upon the character of the in- 
flammation. Respirations accelerated and dyspnoeic Frequent, painful, 
weak cough. Horizontal line of dullness on percussion above which a 
tympanitic sound is observed. Percussion will vary with the position of 
the body of the patient. In early stages friction sounds are heard on 
auscultation, later when much effusion of exudate takes place no respira- 
tory sounds are audible. 

Pneumothorax. Attends interstitial emphysema of the lungs or pene- 
trating wounds in the chest wall. Tympanitic percussion sound in the 
upper portions of the thorax. Severe dyspnoea. 

e. Infectious Diseases Which Involve the 
Respiratory Apparatus. 

Contagious pleuro-pneumonia of the horse. ( Brustseuche. ) This is a 
contagious pneumonia affecting the parenchyma of the various organs 
and is usually attended with secondary pleuritis. i. Stadium incre- 
menti begins with high fever, ^-ellow discoloration of the visible mucous 
membranes, general weakness, crackling of joints. 2. Acme. Does not 
appear before the second or third day. Symptoms of fibrinous pneu- 
monia with or without pleurisy, usually unilateral. Rusty brown nasal 
discharge, empty percussion sound with resistance under the hammer, 
bronchial respirations. Pleuritis: Empty percussion sound limited by a 
horizontal line above which is a tympanitic zone. Friction sounds which 
soon pass away, later no sound or bronchial respiration. 3. Stadium 
decrementi. The crisis appears in 7 or 8 days, temperature within 24-36 
hours down to normal, all other symptoms, also pulse frequency gradu- 
ally disappearing in 8 days. Complications: pleurisy, acute myocarditis. 
Resulting diseases: pulmonary gangrene, abscesses in the lungs, chronic 
pneumonia. 

Scalma (Dieckerhoff) is a diffuse, infectious bronchitis with sub-acute 
course. 

Tuberculosis. Tuberculosis is a contagious disease cause! by the 



RESPIRATORY APPARATUS. 115 

bacillus tuberculosis and characterized by the formation of very small 
inflammatory centers which soon underjro dej^eneration. Only advanced 
cases can be diagnosed by physical examinaticn. Drv cough, chronic 
lung trouble with gradual emaciation, percussion shows dullness in 
patches, also tympanitic sound. Exaggerated vesicular respirations, 
rales, piping and whistling tones on auscultation. Repeated mild bloat- 
ing. Nymphomania, chronic metritis and mastitis in cows, enlargement 
of lymph-glands. See special examination fur tuberculosis. 

Strangles. Coryza contagiosa is an infectious catarrh of the mucous 
membranes of the upper respiratory passages with .secondarv, purulent 
inflammation of their corresponding Ivmph glands. Begins with fever 
of intermittent character. Pulse at fir'.st little increased but may reach 
80. Nasal discharge serous, mucous or purulent, usuallv bilateral and 
profuse. In 3 or 4 days at latest inflammatory swelling of' the sub-max- 
illary lymph glands, which in 4 to 8 days later have abscesses formed in 
them. Pharyngitis frequently concomitant. Dvsphagia, ab.scess forma- 
tion in the subparotid and retro-pharyngeal lymph glands. If larynx is 
involved: cough, loud inspiratory noises. In old horses disease often 
limited to the pharynx 

Glanders, malleus, is a contagious disea.se of solidungula, caused by 
the Bacillus mallei, characterized by the formation of nodules and ab- 
scesses in the re.spiratory mucous membrane and skin. On the na.sal 
mucous membrane we find gray nodules as large as millet seeds, trans- 
parent and surrounded by a red zone. The nodules become yellow, 
degenerate, form ulcers with raised and jagged borders and lardaceous 
bottom. Nasal discharge slight, frequently unilateral, varvinglv sticky, 
slimy, purulent, occasionally discolored and bloody. Intermaxillary 
lymphatic glands enlarged, knottv, firm, adhering to bone or skin. In 
skin and subcutis rather flat, painful, hot nodules varving in size up to 
that of a hen's egg, the.se break, discharge discolored pus and become 
ulcerous. Lymphatics efferent and afferent to the.se nodules are en- 
larged to thickness of a finger. See also specific examination for glan- 
ders 

Contagious pieuro-pneumonia of cattle is a contagious croupous interstitial 
pneumonia. We distinguish an occult stage which is marked by a slight 
cough, fever, and slight dyspnoea. In the accute stage we have distinct 
^^■^'' — 4i°C [105. S°F] and the symptoms of an acute pleuro-pneumonia. 
Great dyspnoea, weak, short cough, some nasal discharge, extended 
e>/ip/v sound on percussion, friction bruits, bronchial respiration, rales. 
Appetite, rumination and secretion of milk suspended. 

Malignant catarrhal fever is a specific di.sea.se of the ox, has a subacute 
course and affects chiefly the re.spiratorv and digestive mucous mem- 
branes, and the brain. Disease is introduced with chills. Great mental 
depression, muscular trembling, stiffness, sometimes inabilitv to .stand. 
Conjunctivitis and keratitis. Diphtheritic inflammation of the mucous 
membrane of the nose, sinuses of the head, trachea and mouth, rattling, 
wheezing and breathing. No appetite, secretion of milk suspended. 

• fl'**^'"P*'" °^ ^°P '^ ^ ^'ery contagious disease that is characterized 
chiefly by catarrhal affections of f.:e mucous membranes. Svmptoms 
quite varied; we di.stinguish: catarrhal, nervous and exanthematous dis- 
temper. vSymptoms of the disease develop .'^lowlv. Animals are indis- 
posed, conjunctivitis, keratitis, vomiting, disturbed appetite, slimy na.sal 
discharge, cough, dyspnoea, tympanitic and occasionally dulled 'sound 



116 CLINICAL DIAGNOSTICS. 

on percussion of lungs, rales. Spasms affecting the whole body or only- 
certain groups of muscles, general muscular weakness, paralysis. Vesic- 
ular and pustular exanthema. 



8 Digestive Apparatus. 

Diseases of the digestive apparatus are common in domes- 
tic animals. Their diagnosis is, in some respects, far more dif- 
ficult than that of the respiratory apparatus because the organs 
in the former case are not as accessible to examination. For 
this reason every possible factor must receive most careful con- 
sideration. We observe them in the following order: 

I. Food and Drink. 

II. The Buccal Cavity. 

III. The Pharynx and Oesophagus. 

IV. Rumination. 
V. Vomiting. 

VI. The Abdomen. 

VII. The Intestinal Evacuations. 

I. Food and drink. Before examining the various organs of 
the digestive apparatus, we must note the animals appetite for 
food and drink and also the character of these latter, also ob- 
serve the way in which the animal takes its food, masticates 
and .swallows it. 

Appetite for food. The degree of appetite that an animal displays 
toward a certain food depends on the palatability of Ihe food and also on 
the degree to which the animal has accustomed itself to it. This must 
always be borne in mind when probing for the cause of poor appetite, 
and hence an inspection of the food must not be neglected. Individual 
appetites vary widely. One horse may be a good feeder, another a poor 
feeder, both may enjoy perfect health. High strung horses often refuse 
their food after active exercise, but their appetite returns after a short 
rest. A change of stable or unaccustomed loneliness has a marked effect 
on the appetite of some sensitive horses. Of the various grains horses 
prefer oats and indian corn and of the grasses sweet timothy or meadow 
hay. Oats is by far the most suitable grain to feed a horse. 

In all serious cases of disease the appetite is more or less 
affected, hay or straw are usually the last part of the ration 
refused. Defective appetite alone is never an 



DIGKSTIVE APPARATUS. 



117 



ndication of any particular disease. As a 
rule, complete loss of appetite is an unfavorable symptom; on 
the other hand, a good appetite in the course of a severe dis- 
ease may be regarded as a favorable symptom. 

Desire for water depends in the first place on the 
amount of water contained in the feed; dry feed requiring 
more water than green feed; of course some water is required 
in both cases. The demand is also affected by the amount c»f 
water given off through the skin, kidneys and intestines. Many 
horses are very sensitive in the matter of impure water, some 
even refuse "pure" water if of a different kind than that to 
which they have .been accustomed [e. g. spring water and rain 

water] . 

The desire for ivatcr is diminished in colic and in all serious 
gastric and intestinal affections, providing no diarrhoea exists^ 
horses with acute cerebritis also refuse water. Continued re- 
fusal of water is on the whole considered as ari unfavorable 
sign; when horses with colic drink water it is regarded as a 
favorable sign. 

Thirst is increased in the course of various diseases: 

i) animals with fever like small sips of fresh water at 
frequent intervals; 

2) when the crisis- occurs in influenza or contagious 
pleuro-pneumoniaof the horse, increased renal secre- 
tion and thirst go hand in hand; 

3) exudative pleuritis and peritonitis; 

4) diabetes insipidus of horses is attended with marked 
increase of thirst; several pailfuls are taken at a 
time; 

5) gastric and intestinal catarrh [diarrhoea] of dogs- 
attended with frequent vomiting. 

By the term perverted or depraved appetite we mean the 
craving of unnatural food by otherwise healthy [?] animals. 
As a rule this is a very important symptpm. Of course this 
condition must not be confounded with playfulness of young 
animals which gnaw at, bite and even swallow almost anythmg 



118 CLINICAL DIAGNOSTICS. 

of convenient consistency and size. Thus cattle will lick at 
ones clothes, dogs eat blades of grass. 

A craving for alkalies is pathological: e. g. straw soiled 
with urine and feces, whitewash etc. on walls, wood; acids in 
dyspepsia. 

Szcallowinj indii^estible substances, like cloth, leather, 
wood, stones, and similar objects is observed in lick disease of 
cattle, and wool eating of sheep; in rabies the same vice is ob- 
served. 

Manner cf taking food. Healthy horses grasp the food with 
their lips and pass it into the mouth, then with the aid of the 
tongue and cheeks it is forced between the molars. Sheep and 
goats do likewi.se. Healthy cattle grasp their food with the 
extended tongue, curved like a hook. 

In horses the following changes are observed: 

1 ) in inflammatory swelling of lips and cheeks as well as 
in paralysis of the cheeks (facial or 7th nerve), horses take up 
their food with their teeth and experience difficulty in getting 
it into the mouth. 

2) in cerebral depression they show similar peculiarities; 
while drinking they may insert the nostrils below the level of 
the water and "masticate" it; 

3) in tetanus feeding is very laborious; mastication and 
suction movements are impossible because the spasmodic con- 
traction of the masseier muscles has closed the buccal cavit}'. 

In cattle normal feeding is disturbed in inflammatory 
affections of the tongue (actinomycosis), this organ often be- 
coming hard and rigid (woody tongue). Cattle thus affected 
grab their food like dogs. 

The manner of drinking water must also be 
observed. Normally only dogs and cats lap their drink. 
When the facial nerve is paralyzed animals must insert the 
whole mouth into the water so that they can get it near 
enough to the pharynx to swallow it. 

Mastication. The briskness with which this act is performed 
bears a direct relation to the palatability of the food and the 



DIGESTIVE APPARATUS. 119 

appetite of the animals; healthy horses and cattle make 60-100 
masticatory movements per minute. 

Masticato}}' movcmmts are conspicuously retarded \xi cerebral 
depression, in the course of severe fevers, and in acute and 
chronic hydrocephalus^. The animals cease masticating for 
some time, seem " absent minded," and forget to eat. This 
often happens while the mouth is full of feed, and pieces of 
hay and straw sticking out of it. 

Mastication is made difficult in paralysis of the facial nerve; 
here the food collects in large masses in the lower part of the 
mouth; it is also observed in tetanus or spasms of the mastica- 
tory muscles due to other causes. 

Mastication is impaired and laborious when mechanical 
defects of the teeth exist. Shear jaws, and irregular teeth, 
projecting teeth, etc. The animals masticate one-sided, 
cautiously and "easy;" they don't masticate thoroughly, the 
food is "crushed and bruised" but not "ground." 

Mastication is painful when acute inflammatory conditions 
exist in the cheeks, temporo-maxillary articulation and in the 
intermaxillary space as they occur in the course of distemper 
of horses. Mastication may be voluntarily interrupted. If 
sharp or pointed objects like nails, needles, splinters of wood, 
etc., are taken up with the food hor.ses open their 
mouths wide and allow the contents to drop out, 
aiding with the tongue. They do the same thing when in- 
juries are produced by sharp teeth or displaced teeth (alveolar 
periostitis); sudden pain, produced by biting on a diseased or 
loose tooth, produces the same effect. Horses with diseased 
teeth frequently drop small masses or balls of food into 
the manger, "quibbing". Some horses suddenly raise 
their head while masticating and hold it sideways, open the 
mouth and continue masticating in a cautious manner, at the 
same time making slow lateral movements with the lower jaw. 
Varied as the symptoms that occur in the course of different 
affections of the teeth may be, they all have one 



120 CLINICAL DIAGNOSTICS. 

thing in common, they make masticatioii 
difficult and painful. 

In dangerous diseases we often observe gnashin'f of the 
teeth, at the same time this is not a " prognostically unfavor- 
able" sign. 

Difficulties in deglutition. Deglutition is the closing act of 
feeding. It is described as occurring as follows: The lips are 
dosed and the jaws are set together, then the tip, the back 
and the base of the tongue are successively pressed against the 
palate and thus the contents of the buccal cavity are forced 
into the pharynx. By contraction of the muscles of the phar- 
ynx in front of the food mass the peristaltic motion thus inau- 
gurated carries the bolus into the oesophagus. At the same 
time the pharynx is slightly raised and the pressure exerted 
on the epiglottis by the base of the tongue, which projects 
backward, closes the larynx and allows the food to glide over 
it. The nasal openings leading into the pharynx are closed 
during this act by a raising of the soft palate and a coming to- 
gether of the borders of the posterior pillars of the fauces 
brought about by contraction of the muscles of the pharynx. 

A disturbance of normal deglutition is 
most frequently caused by inflammatory processes in the phar- 
ynx that cause infiltration and disturb the function of the local 
muscles. The result is not only a painful condition during 
swallowing but the closure of the larynx or nasal cavities may 
be incomplete. Accordingly we may observe manifesta- 
tions of pain, extended head and neck, the animals 
often shaking their heads. Incomplete closure of the phar- 
yngeal openings results in food particles entering the larynx 
or nasal cavities and giving rise to cough, or ejections of 
water, saliva or food through the nostrils (regurgitation), as the 
case may be. The degree to which the closure of the pharyn- 
geal openings is imperfect, bears a direct relation to the sever- 
ity of the affection. In mild cases, fluid only is regurgitated, 
noticeable while drinking water. L,ater on as the case be- 
comes aggravated, solids also pass out. When the affection 



DIGESTIVE APPARATUS. 



121 



is mild and restricted to one side the regurgitation may also 
be unilateral. Soft feed is more apt to cause regurgitation 
than are solid substances. An inflammatory affection of the 
pharynx that causes difficulties in deglutition may be primary, 
(pharyngitis), or secondary to other diseases: distemper, mor- 
bus maculosus, anthrax. 

In addition, difficult deglutition is observed in: 
i) paralysis of the pharynx in mycoses, parturient 
paresis, and rabies; 

2) spasm of the pharyngeal muscles in tetanus; 

3) tumors of the pharynx; actinomycoma, lymphoma. 
Besides the symptoms of difficult deglutition we observe 

in addition: salivation, foaming at mouth,- ejecting food from 
mouth while coughing, retention and fermentation of food in 
mouth cavity. 



Fig. 28. 




Inspection of the Mouth Cavity. 

11. The buccal cavity. We usually examine the buccal cav- 
ity by daylight and without the aid of instruments; artificial 
illumination with reflectors, lamps, or electric lights is some- 
times useful but not necessary. 



122 CLINICAL DIAGNOSTICS. 

Method of examination. In the horse and ox the hand is passed into- 
the mouth at the bars, the tongue firmly grasped, and the thumb pressed 
against the palate. This procedure will, as a rule, cause the animal to 
open its mouth wide. Another practical method consists in grasping 
with the hands, on both sides, the upper lips at the comm issures and: 
resting the thumbs against the palate. In dogs and cats we grasp, with 
our hands, the upper and lower jaws, at the same time pressing the lips 
between the teeth; hereupon the animal opens its mouth wide enough to- 
permit inspection. 

Restless animals must first be secured and then towels or cords are 
passed between the dental arches, and by means of these the jaws are 
forced apart. 

In examining the mouth the following should be ob- 
served : 

The temperature is elevated in fever and in local inflamma- 
tions of the mucous membrane, stomatitis and also pharyn- 
gitis. 

Secretion of saliva. Secretion is diminished in 
all acute febrile diseases, severe intestinal affections, and, as a 
rule, in colic. 

An abnormal quantity of saliva in the mouth 
results either from the fact that the animal does not swallow 
the normal secretion (dysphagia) or that an abnormal secre- 
tion has occurred, as in simple catarrhal or traumatic stoma- 
titis, disea.sed teeth, foot and mouth disease, stomatitis pustu- 
losa contagiosa, malignant catarrh, mycoses, etc. The saliva 
passes off in the form of clear strands or in the form of foam 
produced by masticatory movements. In epilepsy this foam, 
is-observ^ed at the commissures of the mouth. 

Odor from the mouth. An ''insipid sweetisli' odor is ob- 
served when decomposing food-particles, epithelial cells or sa- 
liva in the course of stomatitis catarrhalis, are present. K pu- 
trid odor is produced by decomposition of nitrogenous sub- 
stances. Exudates are present in malignant catarrh and 
stomacace in dogs. A carious odor is produced by suppurative 
processes in bones, especially in alveolar periostitis. 

Specific morbid conditions. Clamminess of the buccal mucous 
membrane occurs in digestive disorders (loss of appetite); red- 
denin'i and szvcllinj of the mucous membrane with loss of sub- 



DIGESTIVE APPARATUS. 123 

stance is observed afier the action of irritants and caustics 
[chloral hydrate pills] . Simple catarrh is attended with simi- 
lar but milder symptom?. 

Pundiform hcvion/ia les occur in morbus maculosus and 
leucsemia. A^odulcs, pustules and ulcers in stomatitis pustulosa 
contagiosa; Ulcers on the gums in stomatitis ulcerosa, calf 
diphtheria, swine plague, mercury and lead poisoning. Blis- 
ters in foot and mouth disease, small isolated yellowish vesicles 
in stomatitis vesicularis. Wounds at the tongue tip and fren- 
ulum are produced by rough handling of the bridle bit; sharp 
teeth produc; wounds on the inside of the cheeks, and sides of 
the tongue. 

Foreign bodies are of frequent occurence in horses [corn 
cobs], dogs, and cats, rare in other animals; they consist of 
pieces of bone, needles, etc. , occasionally ring-like objects slip 
over the tongue accidentally: e. g. cross sections of the aorta, 
intestines, trachea, iron rings, etc., [rubber bands slipped on 
intentionally by children during play]. The symptoms 
are; open mouth and salivation, attempts at removal on part of 
the animal, eating and drinking interfered with, the tongue 
swollen. 

Careful manual as well as ocular exam- 
ination is often necessary to recognize 
these conditions. 

Condition of the teeth. Examination of the teeth of horses 
is of particular importance on account of the frequent occur- 
rence of diseases and malformations of these organs. In dogs 
diseased teeth are also common. 

Abnormal position of the incisors ( par- 
rot mouth and pike mouth) point to the existence of a similar 
defect in the molars. Parrot mouth is not an unconmion 
occurrence in high bred colts. In ruminants the incisors are 
normally loose. Carious incisors and molars occur in dogs in 
the course of rachitis, distemper, anaemia and stomacace. 

Careful examination of the molars, with 



124 CLINICAL DIAGNOSTICS. 

the aid of a speculum* is indicated when horses re- 
ject food after partial mastication, when they show an}' abnor- 
mal masticatory movements, and when large quantities of 
coarse food particles occur in the droppings. The friction 
surface and the lateral faces of the teeth can be examined sim- 
ultaneously by letting the index and middle fingers gUde over 
the former, the thumb and the remaining fingers over the lat- 
ter. Abnormal conditions of the teeth can usually h&felt far 
better than they can be seen. We should observe the pres- 
ence or absence of sharp points, slanting friction surfaces, 
shear jaws, iiiterriiptedjazcs, projecting teeth, short teeth, cari- 
ous and broken teeth, cavities, etc. 

III. Throat and oesophagus. Examination of the throat and 
oesophagus is restricted to external inspection and palpation. 

Inspection. Diffuse swellings in the region of the 
pharynx occur in phlegmonous conditions of the mucous mem- 
branes (pharyngitis). Circumscribed swellings in- 
dicate the presence of abscesses and tumors. 

Palpation. Increased temperature and sensi- 
tiveness indicate acute inflammation which may be either 
diffuse (pharyngitis) or circumscribed (development of ab- 
scesses). The consistency is firm, yet yielding; even in 
abscess formation distinct fluctuation is rarely present here. 
Circumscribed painless swellings of firm consistency indicate 
the presence of tumors, usually melanosarcoma in old gray 
horses and actinomycoma in cattle. Palpation of the 
oesophagus serves to detect the presence of foreign bodies, 
mostly observed in cattle in the form of pieces of potatoes, 
apples, corn cobs, etc. CEsophageal diverticula and stenoses 
cause periodically recurring occlusions of the oesophagus. 
Ingestion of food causes the oesophagus to distend — sausage 
like. Such animals cease eating, or, when they attempt to 

'■'[For horses a speculum is not in all eases necessary for the detection of de- 
fects or other abuormal couditioas of the teeth. By passing the hand into the mouth 
at the bars, at the same time pushing the tongue to the opposite side that organ 
is forced between the molar teeth ou that siae and the auimal will voluntarily 
keep its jaw.s sufficiently separated to permit examination of the condition of the 
teeth without endangering the safetyof the operator. The right molars are exam- 
ined with ihe right, the left with the left hand, the operator facing the animal. J 



DIGE.STIVE APPARATUS. 125 

eat or drink, regurgitation through the nostrils of the ingested 

mass takes place. 

Examination with a probe or probang has no special 

value; the dilated oesophagus, regurgitation, vomiting of food 

and sj'mptoms of choking are sufficient to base upon them the 

diagnosis diverticulum a?id sicfiosis, two conditions usually 

coexisting. On the other hand, the fact that a probang can be 

passed freely through the oesophagus does not exclude the 

presence of these conditions. 

IV. Kumination. Rumination is a specific physiological act of the 
digestive apparatus of ruminants. These animals feed by taking up food 
hurriedly and swallowing it after little or no mastication. After ingesting 
a sufficient amount of food in this manner, the latter, which by this time 
has become partly macerated by the saliva which accummulated with it in 
the rumen, is carefully reinasticated. During this act the animals prefer a 
recumbent position. The food is forced into the mouth by a contraction 
of the second stomach or reticulum into which it previously passes from 
the rumen. Every cud is subjected to about 60 masticatory movements 
and is then re-swallorvcd, this time passing directly into the omasum and 
abomasum or true stomach through the oesophageal groove. The whole 
act of rumination requires from one to two hours. When cattle are 
driven or oxen put to work before they had time to finish ruminating, 
this act is temporarily suspended to be resumed at the next period of rest. 

Slight disturbances of the act of rumination can as a rule 
not be recognized as such. 

Considerable deviations from the normal or 
complete suppression of rumination alone are definite signs of 
disease. 

In the beginning disturbances in rumination due to dis- 
ease manifest themselves bj' a reduction in the number of cuds 
chewed in a certain time, by the number of masticatory move- 
ments applied to each cud before being swallowed and by the 
rapidity with which the animal masticates. 

The severity of the disease corresponds to the degree to 
which rumination is interrupted. In severe diseases rumina- 
tion ceases entirely. 

Rumination is disturbed in: 

a) [all severe febrile and painful affections, surgical 
diseases.] 

b) gastric and intestinal disturbances, especially over- 



126 CLINICAL DIAGNOSTICS. 

loading and paralysis of the paunch. 

c) traumatic inflammation of the stomach and dia- 
phragm. 

d) [all cachectic diseases.] 

e) [many cerebral diseases.] 

Eructation or belching occurs normally in ruminants only. 
This consists in audible expulsion of paunch gases through 
the oesophagus and mouth. [Eructations become distinctly 
audible and abnormally frequent during fermentation processes 
in the paunch, slight tympanitis, etc. Sometimes they are 
accompanied by disagreeable odors (fermentations) but the 
character of the food also plays a role here (onions).] 

V. Vomiting. Vomiting is a reflex (involuntary) spas- 
modic evacuation of the stomach or paunch contents through 
the mouth or nasal passages. This act is assisted by simul- 
taneous contraction of the abdominal and inspiratory muscles. 
Immediately preceding the act of vomiting animals make a deep 
inspiratory movement. Vomiting is caused by indirect (rarely 
direct) stimulation of the vomiting center in the medulla 
oblongata. 

The ease with which vomiting occurs in our domestic 
animals varies with the species according to the anatomical con- 
struction and the degree of fullness of the stomach. Carnivora, 
pigs, and birds vomit most readily and with greatest ease, 
ruminants less so. Horses rarely vomit. This is explained by 
the anatomical structure and position of the stomach. [The 
stomach of the horse is comparatively small and even when 
filled does not always come into contact with the floor of the ab- 
domen, hence is not easily affected by abdominal contractions.] 

Further, the spiral arrangement of the muscular coats, 
insertion of the oesophagus at the middle of the stomach, its 
contracted and thickened wall at the point of insertion (in 
contrast to the funnel shaped thin walled structure of this or- 
gan in other animals) and the large fundus of the horse's stom- 
ach must be considered in this connection. 

A vigorous contraction of the stomach will serve to over- 



DIGESTIVE APPARATUS. 127 

come these obstacles and vomiting may occur in the horse. 
In such cases, however, there is always danger of rupture of 
the organ. This is the usual result when the stomach is well 
filled with food. Vomiting in the course of colic is therefore 
always a serious symptom. If, however, the stomach of the horse 
is moderately filled zvith fiiiid contents, a riiptiire need not occur. 
In such cases the act of vomiting is usually not caused by an 
overloaded stomach but by direct stimulation of the vomiting 
center. (Chloroform narcosis, hemorrhages and inflammations 
near the medulla). 

Vomiting is always a symptom of dis- 
e a sp and occurs under the following conditions: 

a) during the presence of foreign bodies in the larynx 
or at the base of the tongue: pieces of bone, fish bones, 
needles, feathers, etc. , also when tough, stringy mucus col- 
lects in this region in the course of pharyngitis and laryngitis; 

b) obstruction of oesophagus; 

c) gastric affections, overloading of stomach, gastritis, 
and in certain poisonings; 

d) intestinal affections, such as prevent the normal 
progress of food masses through the lumen of the intestine 
and thus provoke antiperistaltic movements which cause the 
stomach to become distended with intestinal contents, irrita- 
tion of its mucous membrane, and vomiting. 

The character of the vomited material may often serve to 
determine ihe cause of the act and the origin (stomach or in- 
testine) of the ejected mass. 

VI. The Abdomen. Examination of the abdomen is con- 
ducted according to the following general rules. 

Inspection. The volume or circumference of the abdomen 
in domesticated animals is subject to great variations and great 
care must be exercised here in diagnosis. For clinical purposes 
the size of the abdomen must always be considered in connec- 
tion with the general condition of the animal, its general make 
up, feed, care, etc. Animals habitually kept on voluminous 
food in ample abundance develop a voluminous abdomen. A 



128 CLINICAL DIAGNOSTICS. 

good plan is to inquire of the owner as to the former or usual 
condition of the animal in this respect. Circumscribed enlarge- 
ments are usually of interest from a surgical point of view. 
Abnormal distention of the abdomen may be due to: 

a) pregnancy; the form of the abdomen becomes barrel 
shaped — increasing bilaterally. 

b) accumulation of abnormal quantities of food in the 
digestive tract (in horses the caecum and colon, in ruminants 
the paunch and other stomachs, in dogs the stomach). In 
these cases the distention is due either to increased consump- 
tion of food (overfeeding) or to accumulation of food taken 
in normal quantities during inactivity of the bowels (constipa- 
tion). In these cases the normal tympanitic tone is replaced 
by a dull one. 

c) the accumulation of gases produced by fermenting 
food. In this case the distention is in an upward direction, 
the hollow of the flank is raised, and the abdominal walls be- 
come distended (tympanitis, bloat). The rapid production of 
gas may be due to the character of the food [legumes, crucif- 
era, etc.] or to suspended activity of the bowels. 

d) accumulation of fluid (transudate and exudate) in the 
peritoneal cavity. This is occasionally seen in dogs, rarely in 
horses. In this case the distention ife in a downward direction , 
symmetrical and bilateral, fluctuation is observed and percus- 
sion reveals a dull area bounded above by a horizontal line. 
When a dog thus affected is raised to a vertical position the 
dull area is shifted (ascites). • 

e) tumors in the abdomen; liver (ecchinococci and car- 
cinoma), spleen (leucaemia), glands, etc. 

f ) dropsy of foetal membranes. 

Abnor7nal reduction in size of the abdomoi may be due to: 
a.) long co7itinued starvation, or, if in spite of good care, 
abundant food and sufficient rest an animal shows this symp- 
tom we may conclude that lack of appetite is at fault (digest- 
ive disorders). 



DIGESTIVE APPARATUS. 



129 



:;r b- ) in senoiis subacute diseases; in such cases tlie ani- 
^mals general condition may still be good. 

c. ) during or following severe diarrhoeas, or after colic 
when strong purgatives were prescribed. 

d.) violent contraetion of the abdominal muscles in pain- 
ful affections of the hind legs. 

Palpation. The object of palpation is to ascertain the con- 
sistency of the bowel contents and whether or not painful con- 
ditions exist. In ruminants the peristaltic motion of the 

Fig. 29. 




H. Reticulum; L. True Stomach; — • — Liver; \~ Area of 
I'ercussion for the Lung. 

paunch can also be observed by palpation. Palpation of the 
bowels per rectum is of especial value in large animals. 

In horses the abdominal walls are thick and tense; this 
and the fact that during an examination the animals frequent- 
ly contract their abdominal muscles increases the difficulty of 
arriving at accurate results as to judging of the condition of 
the abdominal organs, their contents, etc. In cattle the ab- 
dominal walls are thinner, hence the results of palpation are 
more accurate and satisfactory; in sheep this is true to a still 
greater degree. 



130 CL,TNICAI, DIAGNOSTICS. 

Dogs habitually contract the abdominal walls when these 
are manipulated but soon relax them again. In dogs both 
sides are palpated simultaneously, and by exerting pressure 
from both sides toward the median line the entire abdominal 
cavity may be thoroughly examined. 

Palpation serves in the first place to inform us as to the 
degree of contraction (the tenseness) of the abdominal walls 
and the consistency of the bowel contents; the latter should be 
soft and easily compressible. If impressions are made by pres- 
sure they should soon be effaced by the effects of peristalsis. 
Large quantities of fluid bowel contents produce fluctuation. 
Neoformations (tumors) are recognized by the extreme resist- 
ance they offer to pressure. In dogs accumulated fecal mass- 
es [and intussuscepted intestines] can readily be felt. Foreign 
bodies in the stomach and intestines can also be detected by 
palpation providing the normal bowel contents are previously 
evacuated [medicines or clysters] . 

Another object of palpation is to ascertain painful condi- 
tions or abnormal sensitiveness. Even healthy horses are 
often extremely sensitive to pressure exerted on the abdomen 
and become restless when subjected to such an examination. 
Care must therefore be observed not to mistake these symp- 
toms for something more serious. In cattle it is different, be- 
cause abnormal sensitiveness in these animals always points to 
the existence of important lesions. 

Sensitiveness to pressure between the 6th and 8th ribs 
(opposite the reticulum) points to the possibility of an injury 
to the diaphragm from a foreign body that penetrated the retic- 
ulum. In acute affections of the true stomach cattle evince 
symptoms of pain on palpation of the hypochondriac region. 
Palpation of the right flank in cattle, when intussusception of 
the small intestine exists, is also attended with symptoms of 
pain. Foreign bodies in the intestines of dogs produce symp- 
toms of pain when pressure is exerted. 

In cattle the peristaltic movements of the paunch are an 



DIGESTIVE APPARATUS. 131 

important consideration. Normally these can be felt in the 
hollow of the left flank at the rate of about two per minute. 
The food masses are moved from below upward and toward 
the right side. Every contraction of the paunch is attended 
by a slight rise in the hollow of the flank followed by a some- 
what more sudden drop or depression. Imperfect or slowed 
movements of the paunch point to the existence of some patho- 
logical condition (overfeeding, tympanitis, paresis of the 
paunch, peritonitis, adhesions of the paunch with the abdomin- 
al wall). 

Palpation of the bowels per rectum. This is possible only 
in the comparatively large rectum and roomy pelvis of the 
horse and ox, but on the other hand the proportions are so 
large here that only a part of the abdominal region can be thus 
explored. In the region within our reach we can determine 
position and contents of the abdominal organs, also the pres- 
ence of foreign bodies and tumors. 

Method of procedure. To make a thorough examination it is 
often necessary to introduce the arm its full length. A shirt 
without a sleeve can be worn to advantage on such an occasion. 
[After carefully paring the finger nails] the arm should be 
well covered with oil, or soap (castor oil answers the purpose 
well) and then, with the tips of the fingers forming a cone, 
the hand is carefully introduced into the rectum. During the 
examination the animal's head (if a horse) is held up, and the 
forefoot on the side where the operator stands is raised, b>- an 
assistant. Nervous or excitable horses can be secured with a 
twitch or the operator can protect himself against kicks by 
having the animal standing close to a stable partition, the op- 
erator standing on the opposite side. The left half of 
the abdominal cavity can be examined most satisfacto- 
rily with the right hand, the right half with the left hand. 
Since perforations can be produced it is advisable to proceed 
with the utmost care in making rectal examinations. 

If accumulated food masses, contraction of the rectum, or 
the presence of gases retards the easy introduction of the hand 



132 CLINICAL DIAGNOSTICS. 

simultaneous infusions of water should be given to facilitate 
the operation. It is always a good plan to insert the arm 
nearly its full length before beginning our examination. In 
this way a long piece of the rectum slips over the arm and 
there is less danger of pulling or straining the mesentery. 
This danger decreases as the length of the mesentery increases 
anteriorly. 

Exploration per rectum is indicated in chronic colic and 
in all cases of colic in stallions and cattle. Palpation may 
serve to determine the following points : 

I. Fullness and position of the bowels 
The separate regions of the inte:?tines can be definitely recog- 
nized only when they are filled with food. Mere distention 
with gases does not always enable us to recognize with cer- 
tainty the identity of parts. When the bowels are empty or only 
partially filled with fluids or gases it may be impos.sible to dis- 
tinguish between the large and the small intestine. The longi- 
tudinal muscular bands of the large intestine of the horse are 
the only means of differentiation, and these must be sought. 
Manual exploration per rectum enables us to recognize food 
accumulations or impactions in the following divisions of the 
bowels. 

i) Impactio7i of the floating colon. This is of 
frequent occurrence in its posterior region and can then 
be easily recognized (rectal paralysis); constipation in the 
floating colon is recognized by the nodular character of the 
surface and the sinuous course of the bowel. Its volume is 
appreciably less than that of the colon or caecum. 

2) Impaction of left colon. When well filled with im- 
pacted food masses the pelvic flexure projects into the pelvic 
cavity and frequently toward the right hand. This flexure is 
recognized by its great volume, its curvature and the short 
mesentery uniting the two superposed layers of the left colon. 

3) Impaction of ccecum. The base of the caecum is situ- 
ated in the upper portion of the right flank and is attached to 
the spinal column by means of a mesenteric fold and the pancreas. 



DIGESTIVE APPARATUS. 133 

When distended with food-masses its great curvature, which is 
smooth, projects almost to the right hand border of the pelvis. 
The small curvature can also be recognized and serves to identify 
the organ. The longitudinal muscular bands can also be felt- 

4) Impaction of the ileum. This usually occurs near the 
ileo caecal valve. The impacted intestine courses transversely 
from the left to the right side of the flank. It can be recog- 
nized by its sausage-like form which can be almost encircled 
by the hand. 

The following dislocations or displacements of the intes- 
tine can be diagnosed. 

a) Incarceration in inguinal canal; most frequently ob- 
served in stallions. The intestine can be felt about two or 
three inches in front of the pubic bone and four or five inches 
to the right or left of the median line where it seems to be 
firmly attached. A pull exerted at this point causes the ani- 
mal to evince signs of pain. Simultaneous examination of the 
scrotum (external ) clinches the diagnosis. 

b) Peritoneal hernia or so-called gtd tie of the ox. A loop 
or knuckle of intestine can be felt at the anterior margin of 
the ileum, retained between the latter and the vestige of the 
spermatic cord. The doughy painful swelling, held in position 
by the tense cord which is situated anteriorly, are the charac- 
teristics of this condition. 

c) Invagination of the shtall intestine in cattle. This 
condition is recognized by the presence of a firm but elastic 
sausage-like mass in the lumeti of the intestine, terminating 
abruptly posteriorly but insensibly anteriorly where food masses 
have accumulated. The length of this mass varies with the 
extent of the invaginition. 

d) Torsion of the left layers of the colon in the horse. In 
this condition the tense mesentery can be felt coursing down- 
ward and to the left immediately in front of the entrance to 
the pelvis and just below the 4th lumbar vertebra. A pull ex- 
erted on the mesentery produces symptoms of pain. A second 
tense strand can be felt in the umbilical region (a longitudinal 



134 CLINICAL DIAGNOSTICS. 

band of the inferior layer of the colon which courses from left 
to right). The pelvic flexure has shifted from its normal 
position. 

II. Enteroliths (stones and concretions in the intes- 
tines) can be detected only when the intestines are compara- 
tively empty. The presence of large masses of food interferes 
with their recognition. It is best, therefore, when these are sus- 
pected, to free the intestines of their contents with a purge be- 
fore proceeding with the examination. 

III. Tumors and tuberculous tumefactions of the lym- 
phatics can be recognized only when they have a certain size, 
e. g. that of a hazelnut, and here too a purge must be given to 
remove solid fecal masses before exploration begins, other- 
wise mistakes are easily made. 

Percussion of the abdomen. As a rule the stomach and in- 
testines contain a moderate quantity of gases which distend 
their walls only slightly; hence percussion produces a tympa- 
nitic sound. In the paunch of cattle and the large intestine of 
the horse where food masses accumulate, the sound is at times 
dull tympanitic or even dull. (Topography of bowels at left 
side in the horse; see fig. 25). 

Abnormal accumulations of food masses in the caecum 
and colon give rise to a dull sound and a sensation of resist- 
ance to the finger or pleximetric hammer at points on the ab- 
dominal wall opposite them. If the accumulation of gases 
causes the bowel walls to distend abnormally and become 
tense a clear sound is produced, a sound resembling that pro- 
duced by the healthy lung, only clearer and louder because 
large air chambers are present. (In the lungs the air cham- 
bers are small). 

Bilateral dullness, limited above by a horizontal line is ob- 
served when fluids collect in the abdomen (ascites). This is 
most frequent in the dog; raising the animal to a vertical 
position shifts the dull area accordingly. 

Auscultation of the abdomen. The observation of the various 
sounds produced by the moving along of the intestinal con- 



riGESTIVE APPARATUS. 



135 



tents has for its objects the determination of the character of 
the moven:ents of the bowels. The sounds are produced bj- 
the onward movement of the solid, liquid and gaseous contents 
of the bowels. The gases particularly produce distinctly au- 
dible sounds. In the absence of intestinal contents sounds are 
not produced by peristaltic motion. 

The character of the sounds is determined by the consist- 
Fig- 30. 




B Ca;cum; U Inferior laytr of colon; O Superior layer of colon; 
\~ Limit of percussion area of hmg. 



ency of the intestinal contents and by the quantity of gases 
present. Hence: the sounds of the small intestine are those 
of flowing liquid, gurgling, and splashing: the sounds of the 
large intestine rumbling, cooing, and fumbling. 

The intensity of the sounds corresponds to the intensity 



13(3 CLINICAL DIAGNOSTICS. 

of the bowel movements, and we distinguish, lively, xveak, 
hardly audible, short and prolonged sounds or noise. 

None of the intestinal sounds are continuous, they are 
always interrupted by quiet intervals, but in healthy animals 
these intervals are never long. Practice in auscultation is of 
course necessary to enable us to judge correctly. 

In diseases quantitative as well as qualitative deviations 
from the normal occur. The sounds may be absent altogether 
in certain regions, e. g. , the small intestine may have a lively 
peristaltic motion while the large intestine remains at rest. 

Intestinal sounds are reduced or diminished: 

i) in impaction, constipation and tympanitis, a paralytic 
condition resulting from over distention and overloading 
(colic). 

2) in spasmodic contraction of the small intestine in the 
course of spasmodic and rheumatic colic. 

3) in persistent diarrhoea when the intestinal contents 
are scanty. 

4) in severe inflammatory conditions (because peristalsis 
is then more or less suspended and the intestinal contents are 
scanty (enteritis, peritonitis). 

Very lively and loud intestinal sounds occur in all cases of 
slight stimulation, especially when the latter is produced by 
laxative food: green fodder, raw potatoes, wheat bran [clover 
hay, alfalfa, etc]. 

The sound of a drop of water falling onto a metal plate or 
pan is sometimes observed and belongs to a class by itself. 
It occurs when a loop of intestine is greatly distended and 
the fluid contents of the overlying intestines (small intestines) 
is forcibly flung against it and causes its walls to vibrate. The 
pre-ence of this sound indicates that a loop of intestine is at 
rest and that it is distended with gas. 

VII. Intestinal discharges or evacuations. The quality and 
quantity of the discharges depend in the main on the kind 
and quantity of the food. The amount of water imbibed 
has little or no influence on the consistency of the discharges. 



DIGESTIVE APPARATUS. 137 

The beginner must make an objective study of the char- 
acter of the discharges of different animals .on various foods, 
and in particular cases make comparisons with the- dis- 
charges of other animals kept under the same conditions in 
the same stable. There are many diseases in which the char- 
acter of the bowel discharges is of very great importance. 

Defecation. Defecation is difficult when the feces are dry 
or hard (constipation). Continued rest after and during 
heavy feeding may lead to an accumulation of bowel contents 
or even to constipation. Voluntary defecation is almost impos- 
sible when paralysis of the rectum exists, in such cases the 
agitation of the body during locomotion causes the feces to be 
passively discharged through the gaping anus. 

Involuntary evacuations of the bowels occur in cerebral 
spasms and in paralysis or relaxation of the anus. The latter 
is common in the course of severe diarrhoeas, here the semi- 
liquid feces flow down on the legs. 

Defecation \s paififul in the course of painful inflammatory 
conditions in the abdominal cavity (intestine, peritoneum), 
diaphragm or abdominal walls. These conditions all interfere 
with the normal contraction of the abdominal muscles during 
the act of defecation. In dogs foreign bodies (bones) in the 
intestines, and obstructions by agglutinated hair at the anus of 
long haired dogs, are particularly troublesome. The patients 
groan, cry or howl during attempts at defecation; they avoid 
the act as much as possible and thus bring on constipation. 

Frequency of defecation. Carnivora defecate once or twice 
daily, herbivora much more frequently; horses 8-10 times, cat- 
tle 12-18 times. These figures are increased by bodily exer- 
cise — particularly in horses that travel much. 

When the normal frequency of defecation is reduced, we 
say the animal is constipated. This is mostly the result of 
diminished peristaltic motion which is also attended with in- 
creased absorption of fluids. Constipation may result from 
impaction, occlusion, and dislocation of the intestine, first 



138 CUNICAIv DIAGNOSTICS. 

Stages of intestinal catarrhs, inflammations, etc. Constipation 
is the principal symptom of colic, it may occur, how- 
ever, without any other colic symptoms. In ruminants the in- 
gesta are usually retained or retarded in the paunch and oma- 
sum, rarely in the intestines. 

The term diarrhoea is applied to frequent and usually 
copious evacuations of liquid or semi-liquid feces; it occurs in 
all irritated conditions of the intestinal mucous membrane and 
is caused by feed, catarrh and inflammation. Psychic disturb- 
ances may lead to diarrhoea by reflex action. 

Volume of feces. Here we must distinguish between the 
amount passed at a single defecation and the total for a day. 
Well fed horses (stable) pass 2 to 4 lbs. at each act, 20 to 30 
lbs. per day. In acute and in chronic hydrocephalus the vol- 
ume of the evacuated masses as well as the intervals between 
evacuations is increased. The evacuations are increased in 
quantity in diarrhoea following constipation, and after the use 
of evacuants they are diminished after [prolonged diarrhoea] , 
during constipation and when animals are underfed. 

Consistency and form. Under normal and usual conditions 
horses' dung is evacuated in balls of a regular form, which on 
striking the ground usually break. In cattle the dung is 
voided in the form of a semi-solid mass (porridge), which 
flattens out upon striking the ground. Sheep and goats pass 
small firm balls resembling the fruit of the bay-berry. Swine 
and dogs pass feces somewhat more solid than those of cattle 
and frequently quite hard. In all animals the character of the 
food has a great influence on the appearance of the evacua- 
tions. For the horse we use the terms hard, firm, ox loose 
balls, very moist balls, thick gruel-like mass, thin gruel-like 
mass, fluid, watery. 

Increased firmness or hardness of the feces is observed in all 
febrile diseases, in constipation, and in the first stages of intes- 
tinal catarrhs. In severe febrile diseases of cattle (malignant 
catarrhal fever) and in obstinate constipation the feces are dry, 
hard and resemble peat in appearance. 



DIGESTIVE APPARATUS. 139 

Decreased firmness or abnormal so/hiess of (he feces occurs 
in all forms of diarrhoeas; intestinal catarrh, inflammation (my- 
cotic and septic), dysentery of calves [hog cholera], influenza 
of the horse, severe tubercular affections of the mesenteric 
lymph glands. 

The color of the feces is due to admixtures of bile, coloring 
matter in the food (chlorophyll in herbivora, haemaglobin in 
carnivora) and secretions. An admixture of fragments of 
bone, in dogs, produces a light gray color. An exclusive milk 
diet produces yellow feces (bile); green fodder produces a 
greenish hue; oats, straw and timothy hay produce a yellowish 
brown color; corn, beans, rye (especially when coarsely 
ground ) produce a gray or ^^ellowish gray color. In cattle the 
diet is much more varied than in tTie horse, consequently it is 
difficult to determine a normal color It varies from a distinct 
green (in pastured animals) to lighter and darker shades of 
endless variety. Concentrated foods (Kraftfutter) tend to 
produce a more grayish color. 

The following morbid changes may be observed: 

The longer the ingesta are retained in the intestine the 
darker they become. After continued constipation the feces 
of horses and cattle assume a blackish brown, peat-like color. 

A decreased admixture of bile (icterus) produces a gray, 
or light gray color resembling clay. Admixtures of blood pro- 
duce a red, brownish red or chocolate color, sometimes almost 
black. A thorough admixture of the blood with the evacu- 
ated contents points to the occurrence of a hemorrhage in the 
anterior portions of the intestinal tract (hemorrhagic enteri- 
tis, dysentery, etc.). If the hemorrhage occurred in the rec- 
tum the blood adheres in the form of streaks or clots. 

Discolorations are produced by catarrhal and inflamma- 
tory affections. In dysentery of calves the feces are gray or 
grayish white. Some medicines produce specif c colorations of 
the feces: iron produces a black, calomel a green color. 

Covering of the feces. In herbivora the feces are covered with 



140 CLINICAL DIAGNOSTICS. 

a thin pellicle of mucus which gives them a shiny appearance. 
This coating of mucus increases or decreases in thickness as 
the time during which the feces are retained in the intestine is 
increased or decreased. In intestinal diseases attended with 
extensive exudation from the mucous membrane the feces are 
not only coated with mucus but are mixed with it. This 
mucus may be glossj', colorless, yellowish (bile) or gray (epi- 
thelial cells and white blood corpuscles ). Flaky or fenestrated 
coagulations on the surface of feces have their origin in the 
rectal mucous membrane (proctitis). 

Odor of the feces. This varies with every species according 
to the food. Horse dung can hardly be said to have an offen- 
sive or repulsive odor, the dung of the ox has an odor peculiar 
to itself, and the feces of carnivora stink. Horse dung has a 
sour odor in digestive disorders when concentrated food was 
given in abundance. The feces of herbivora stink or have a 
fotd odor when putrefactive processes go on in the diseased di- 
gestive tract. If albuminous exudates (blood) are present 
under these conditions the odor is carrion-like (hemorrhagic 
enteritis, distemper of dogs). 

The chemical reaction of the feces has no particular diagnos- 
tic value. Horse dung, as a rule, has an acid reaction, a 
result of the decomposition processes going on in the large in- 
testine. In digestive disorders and intestinal catarrhs the 
acidity is often increased. 

Composition of the feces. The composition of the feces as 
far as food particles and foreign substances are concerned de- 
mands careful consideration. In the first place the size of the 
undigested food particles must be considered, this indicates the 
degree of mastication or rumination to which they were sub- 
jected. In cattle the feces should consist of a homogeneous 
mass; coarse particles of food always indicate insufficient or 
faulty rumination: overloading of paunch, paralysis or inac- 
tivity resulting from inflammatory affections are the cause of 
the latter. In horses, on the other hand, coarse undigested 
particles of food occur normally in the dung, and faulty masti- 



DIGESTIVE APPARATUS 141 

cation is not indicated unless the coarse particles are very 
numerous and whole or nearly whole grains of corn, etc., and 
bits of straw or hay can be recognized. The cause of the pres- 
ence of coarse particles of food consists either in greedy feed- 
ing or in defective molar teeth. The degree of the defect 
bears a direct relation to the degree of coarseness of the food 
particles. 

Foreign bodies in the feces of horses usually consist 
of sand, and in sheep we find wool. 

Inflammatory products consist of mucus, blood , 
pus, croupous membranes; in chronic intestinal catarrh of cattle 
we often find small clots of blood. 

In cattle and calves suffering with catarrhs or other in- 
flammatory conditions of the digestive tract the soft feces fre- 
quently contain numerous gas bubbles; these are due to gas- 
producing putrefactive organisms which are particularly active 
in concentrated foods that pass rapidly along the digestive 
tract. 

Any parasites of the gastro-intestinal tract may occasion- 
ally be met with in the feces, either entire (Ascarides, Oxy- 
uris) or in segments (proglottides of tapeworms); sometimes 
the eggs only are present Distoma in sheep and cattle) 
When Distoma are suspected a microscopical examination of the 
feces should be made. The eggs of these parasites are yellow- 
ish brown oval bodies or capsules provided with a lid, o. 15mm 
long, 0.1 mm diameter). 

The most common parasites of the digestive tract are as 
follows: 

Horse: Gastrophilus equi and hemorrhoidalis, Ascaris 
megalocephala, Strongylus armatus [tetracanthus] , Taenia 
mamillana, perfoliata, and plicata. 

Cattle: Amphistomum conicum, Ascaris lumbricoides, 
Strongylus radiatus and ventricosus. Taenia denticulata and 
expansa, Tricocephalus affinis, Strongylus infiatus. In the 
bile ducts: Distomum hepaticum and lanceolatum. 

Sheep: Amphistomum conicum, Strongylus contortus, 



142 CLINICAL DIAGNOSTICS. 

hypostomus, filicollis and cernuiis, Taenia expansa, Tricho- 
cephalus affinis, and [Taenia fimbriata] . In the bile ducts: Dis- 
tomum hepaticum and lanceolatum, and [Taenia fimbriata]. 

Goat: Strougylus contortus, hypostomus, filicollis and 
venulosus, Trichocephalus affinis, Taenia expansa. 

Pig: .Spiroptera strongylina, Trichina spiralis, Ascaris 
lumbricoides, Echynorynchus gigas, Strongylus dentatus, Tri- 
cocephalus dispar. In the liver: Distomum hepaticum and 
lanceolatum. 

Dog: Taenia echinococcus, coenurus, marginata, serrata, 
cucumerina, Bothriocephalus cordatus and latus, Ascaris mys- 
tax,Dochmius trigonocephalus, Trichocephalus depressiusculus. 

The discharge of intestinal gases occurs only in horses and 
dogs; corn and green feed produce these gases in large quantities. 
In old cows, with chronic affections of the rectum or undue lax- 
ness of the sphincter ani, air is often sucked in during the act of 
expiration and expelled again at inspiration thus producing a 
sound as though intestinal gases were being discharged. 

Addendum. An examination of the liver and spleen of 
domesticated animals is usually impracticable and in fact of 
little importance because primary diseases of these organs are 
rare. An enlarged liver in the dog can be felt in the region 
of the last rib, in the large animals palpation of the liver per 
rectum may, in rare instances, give valuable information. 
When greatly enlarged the spleen in the horse and the liver in 
the ox can thus be felt and tubercles, echinococci and tumors 
recognized. 



Diseases of the Digestive Apparatus. 

a. Mouth, Pharynx and CEsophagus. 

Stomatitis. Here the morbid changes can be directly observed; three 
forms : stomatitis catarrhalis, st. vesicularis, st. ulcerosa. 

Ptyalism. A continued discharge of large quantities of saliva without 
any assignable cause. 

Pharyngitis, Angina pharyngea. More or less fever according to the 
character of the inflammation. Head held up, neck stiff. Appetite 
present but mastication and especially deglutition impaired. Food and 



DIGESTIVE APPARATUS. 143 

particularly water ejected through the nose. Accumulation of saliva 
and food in the mouth, salivation; foreign bodies (food) in larynx, and 
cough. More or less syniptoms of laryngitis, in serious cases dyspnoea as 
a result of swelling of laryngeal mucous membrane. 

Paralysis of oesophagus and pharynx. Dysphagia paralytica, difficult 
deglutition and absence of inflainmator} symptoms. 

Foreign bodies in oesophagus. Most frequent in cattle [but also observed 
in horses]; salivation, inability to swallow, choking, flow of saliva from 
nose; tympanitis in cattle. Foreign body in cervical portion of cesopha- 
gus can be seen or felt. 

CEsophageal stenoses and diverticula usually develop slowly and gradu- 
ally. Symptoms: sudden interruption in feeding, impaction of oesopha- 
gus with food; regurgitation, choking Discharged masses are foamy 
but not sour. 

Diseases of the teeth in animals produce trouble in feeding. Animals 
begin eating with apparent appetite but soon stop or continue with di- 
minished interest, masticate slowly and carefully, .-mack their lips, pause, 
salivate, reject partially masticated food, swallow their grain whole, mas- 
ticate roughage poorly, don't eat a full feed, feces contain large particles 
of food, .sometimes there is a tendency to diarrhoea. The following con- 
ditions of the teeth are of clinical importance, viz.. sharp teeth, very ob- 
lique grinding surfaces (shear-jaws), an undulating or irregular set of 
teeth, projecting or depressed teeth; caries of the teeth, tartar deposits; 
periostitis alveolaris, tooth fistulae, neoformations on t»lie alveolar perios- 
teum. 

b. Stomach and Intestine of the Horse. 

Acute dysprpsia. Lack or loss of appetite, particularly for grain; ani- 
mals lick cold objects. Thir.st is increased, buccal mucous membrane 
dry, animals yawn frequently. 

Acute gastrointestinal catarrh. Usually fever, animal is downcast, con- 
junctiva reddened, sometimes icteric. Appetite much impaired, fre- 
quent yawning, buccal mucous membrane reddened and clammy; feces 
at first dry, later diarrhoeic; urine acid, without sediment, contains much 
indican. 

Chronic dyspepsia. Chronically impaired appetite. Gastric disturb- 
ances 

1 ) Simple chronic dyspepsia. Appetite for concentrated 
food (grain) impaired, otherwise normal. 

2) Acid dyspepsia. Impaired appetite, but a craving for 
alkalies; licking whitewashed walls, nibbling at soiled litter. 

3) Nervous dyspepsia. This occurs in easily excitable 
horses and consists in temporary disturbances of appetite after excite- 
ment. 

Chronic gastro-intestinal catarrh Gastro-enteritis catarrhalis chronica. 
Soft consistency of feces, or hard and soft alternately, containing mucus, 
appetite impaired. Mucous membranes muddy red Urine acid. 

Colic of horses. The term colic is applied in a general way to patho- 
logical conditions of the gastro-intestinal tract that cause horses to man- 
ifest symptoms of pain. As a rule they are caused by interrupted pro- 
gress of the intestinal contents. The most important symptoms are those 
indicating pain, see p. 32, efforts to urinate and defecate, diminished 
peristalsis and retarded defecation. Sometimes impaction or torsion of 



144 CLINICAL DIAGNOSTICS. 

the bowels can be recognized as the causes (rectal examination). Before 
making a prognosis note carefully the condition of the conjunctiva and 
the pulse. 

Gastro-enteritis. Inflammation of the stomach and in- 
testine. High fever, great depression of the sensorium, mucous mem- 
branes muddy red; pulse very rapid, respiration increased. Complete 
loss of appetite, buccal mucous membrane hot, feces diarrhceic, foul 
odor, and bloody. Rising is painful. Forms: gastro-enteritis rheumat- 
ica, toxica, cruposa, mycotica, parasitica. 

c. Gastric and Intestinal Diseases of Cattle. 

Acute tympanitis. Hoven, bloat. Rapid tympanitic distention of the 
paunch, food and drink are refused, defecation retarded Increased and 
labored breathing, animals are anxious and restless. 

Dyspepsia. Acute derangement of activity of stomach. No fever. 
Feed is absolutely refused, rumination suspended, belching, abdomen 
full, paunch contents firm, paunch movements slight, auscultation re- 
veals sounds of bursting bubbles, feces dry, later on containing coarse 
food particles. 

Acute gastro-intestinal catarrh. Fever, conjunctiva reddened, pulse 
frequent, appetite often entirely wanting, flanks sunk in, paunch move- 
ments incomplete. Milk secretion suddenly retarded. 

Chronic gastro-intestinal catarrh. Gradual development and frequent 
change of symptoms. Appetite reduced, bloating follows a heavy feed, 
rumination interrupted. Defecation usually retarded, feces mixed with 
mucus, now and then diarrhoea. If disease is severe diarrhoea is contin- 
uous. Animal weak, falls off in flesh. 

Chronic tympanitis, chronic indigestion. Periodically re- 
curring attacks of slight bloating of paunch that continue for some time. 
Rumination and paunch movements retarded. Coarse food particles in 
fe ces. 

Dislocation of bowel, i. Invagination (telescoping) of intestine. 
Occurs suddenly and without external cause. Animals are restless, lie 
down, get up again, kick their bellies, groan. These symptoms attended 
with fever. Feeding and rumination cease, ob.stinate constipation, dis- 
charges of mucus and blood. Pains soon grow less but fever increases. 
Palpition per rectum usually enables us to feel the invaginated gut. 

2. Peritoneal h e r n ia or gut tie in the ox. Symptoms same 
as in invagination, in addition an abducted position of hind leg which is 
also extended back. Sacral region depressed. Palpation per rectum re- 
veals presence, at anterior border of ileum, of painful doughy swelling, 
held in place by vestige of spermatic cord. 

Licking disease of cattle and wool eating of sheep are peculiar chronic 
aff'ections; afilicted animals have a habit of licking, nibbling, or even 
swallowing objects of a various -nature, including indigestible and often 
loathsome and disgusting substances. At the same time there is loss cf 
appetite and emaciation. 

d. Infectious Diseases with Localization in 

the Digestive Tract. 
Rinderpest is a readily transmissible, acute infectious disease, of cattle. 
It usually takes a fatal course. Period of incubation 6-7 days. High 



URINARY APPARATUS. 145 

temperature is the first symptom. Eyelids swollen, conjunctiva very red, 
respiration difficult, dirty yello\Aisli nasal discharge, nasal mucous mem- 
brane reddened in spots, cough, moist rales, frequently interstitial pul- 
monary emphysema and cutaneous emphysema; complete loss of appe- 
tite, feces fluid, discolored; secretion of milk suspended, great depression, 
and general weakness of the body. Dark red areas on mucous mem- 
branes which ( spots) become coated with grayish white layers, when the 
latter drop off and leave ulcerous erosions. Most animals die on the 5th 
or 6th dav. 

Stomatitis pustulosa contagiosa is an exanthema with a typical course. 
It occurs in the form of pustules, principally at the mouth, and is char- 
acterized by its mild course. Period of incubation 3-5 days. At first 
appearance of eruption there is fever, but this soon subsides. Horses 
refuse feed, they salivate, mouth painful to the touch. Within 2-3 days 
minute nodules'or blisters appear on the mucous membrane; these are 
at first red, then gray or yellow, break open and form ulcers. Intermaxil- 
lary glands swollen, conjunctivitis, now and then ulcers on the outer part 
(skin ) of the lips, forearm and boly; haaling requires 10 days t) two 
weeks. 

E. Intoxications. 

Lupinosis is an intoxicition disease affecting the body as a whole. It 
is caused by a poi.sonous principle ( lupinotoxin ) which occurs in lupines. 
Diminished appetite, increased temperature, icteric coloration of con- 
junctiva, general weakness, cerebral depression. Urine yellow, contains 
bile pigTtients and albumin. 

[Loco weed poisoning." An intoxication disease affecting chiefly the 
nervous system. Effects n t noticeable until a considerable quantity of 
the "loco' weed" has been eaten. Gait slow and measured, eyes glassy 
and staring, vision interfered with, convulsions when animal is excited; 
later on. general eiuaciation. Occurs in western States.] 

9. Urinary Apparatus. 

In diaj^nosing diseases of the lungs percu.ssion and aus- 
cultation of the chest is of fundamental importance. In dis- 
eases of the urinary apparatus we depend on the results of 
physical and chemical examinations of the urine. Experience 
has taught us that affections of the kidneys and urinary tract 
are not as common in animals as they are in man and con.se- 
quently urinary analy.'^es hardly merit the same importance 
that is attached to them by physicians. Besides this the entire 
field of kidney pathology in animals ha-s received so Httle at- 
tention from investigators that our lack of knowledge is often 
evident to the diagnostician- 

Re.sults of a urine examination often enable us to diagnose 

•■■ U. S. report. 



14G CI.INICAL DIAGNOSTICS. 

afifections of other organs the abnormal products of which pass 
over into the urine. 

The collection of the urine from animals is 
always attended with difficulties, in practice it is often impos- 
sible. As a rule the urine is caught up in a vessel during the 
natural act of the animal. In horses a vessel can be secured 
to the sheath and the urine thus collected. In female animals 
the use of a disinfected catheter is permissable. 

In the course of the clinical examination we consider the 
urine first; if the latter shows material changes we also 
examine the urinarj' organs. 

Accordingly we consider the following points and in the 
order given : 

I. Manner of Voiding the Urine. 
II. Examination of the Urine. 

A. Macroscopical examination. 

B. Chemical examination. 

C. Microscopical examination. 

III. Examination of the Urinary Organs. 

I. Manner of Voiding the Urine. 

In our domestic animals urinating is a reflex act inaugurated by the 
stimulus of the urine on the mucous membrane of the distended 
bladder. As long as the distention of the bladder is below a certain 
point the reflex action of the sphincter vesicae which is also inaugurated 
by the pressure of the urine, supersedes that of the muscular coat, 
hence the one gives way to, or takes the place of, the other as occasion 
demands. 

In adult male dogs only do we observe frequent and voluntary 
urination. For this act they prefer places used for the same purpose by 
other dogs. Their choice places are trees, the corners of houses, etc. 

When urine is voided the bladder contracts and this is aided by 
the abdominal muscles. Every species of animal manifests peculiarities 
of its own in this act, but it is a rule that all animals stand while urinat- 
ing. 

Horses (both sexes) virinate only while resting and cease feeding for 
the time; not infrequently they emit loud groans. 

Cows urinate similarly to mares, male cattle on the other hand uri- 
nate not only while feeding but also \\hile walking; in fact, in these 
animals the act sceins almost to be a passive one. 

Old dogs and pigs (male) void the urine in an interrupted jerky 
stream. 



URINARY APPARATUS. 147 

1.) The frequency of urination depends on the amount of water im- 
bibed, the amount of water lost by respiration, perspiration, and per 
intestinal tract; accordinj<ly it varies very considerably. Healthy horses 
ordinarily urinate 5-6 times a day. 

Abnormal frequency of urination occurs durin<^ increased 
secretion of urine (polyuria) in the course of diabetes, and in 
chronic inflammation of the kidneys, temporarily in the crisis 
of severe diseases (contagious pleuro-pneumonia of horse). 

Urination is suppressed, when rupture of the 
bladder has occurred (urethral calculus) in oxen; to determine 
(in doubtful ca.ses) whether or not an ox urinates a clean 
cloth is tied in front of the opening of the urethra. 

2) Abnormally frequent attempts to urinate, only slight quan- 
tities of urine being passed at each attempt, stranguria. The 
cause of this is an abnormal irritability of the mucous mem- 
brane of the bladder and 1 rethra. Such conditions are most 
frequently observed in the course of colic in horses where the 
distended intestines (impaction, constipation, tympanitis) exert 
a pressure on the bladder, or the sense oi fulness of the abdomen 
causes the animals to make these attempts. Inflammatory condi- 
tions of the bladder (bladder diseases, intone and gravel, neoform- 
ations, poisoning with irritating substances) or of the urethra 
(applications of pepper) are much less common causes. Mares 
in oestrum often show these symptoms at the same time re- 
peatedly protruding the clitoris. 

3) When urination Is painful the term dysuria is applied. The 
animals are restlc-^s, step to and fro, kick at their bellies, switch 
their tails, look back at the abdomen, groan, and void urine in 
drops or thin streams. The seat of the pain may be in the 
bladder or in the urethra (concrements, strictures, inflamma- 
tions). Sometimes the pain is caused by abdominal pressure 
in peritonitis. 

4) Retention of urine (ischury) is attended with accumula- 
tion of urine in the bladder. It is observed: 

a ) in obstruction of the urethra (concre- 



148 CLINICAL DIAGNOSTICS. 

ments, swellings, strictures, tumors). In such cases the urine 
is voided in drops or thin streams, and frequently with symp- 
toms of pain. 

b) in paralysis of the bladder; frequently 
associated with paralysis of the rectum and of the tail. 

5) Inability to retain urine, incontinentia urinae, occurs as a 
result of paralysis or weakening of the sphincter of the blad- 
der, or as a result of diminished sensitiveness of the urethral 
mucous membrane, thus suspending the reflex excitability of 
the sphincter. Most frequently observed in dogs in the 
course of distemper (spinal affection) but otherwise rare in ani- 
mals. 

II. Examination of the Urine. 

A. Macroscopical Examination. 

i) The quantity of urine voided depends on the same con- 
ditions that regulate the frequency of voiding it : on the aver- 
age horses secrete 4-5 liters, cattle 6-12 and dogs ]\-\ liter per 
day. As a rule we determine the quantity of urine voided 
daily by making an estimate. Collecting the urine for actual 
measurement is cumbersome and besides not exact. 

A decrease in the quantity of urine is observed in 

a) profuse sweating and in diarrhoea; 

b) severe febrile diseases; 

c) formation of large quantities of exudates in the pleu- 
ral and peritoneal cavities; 

d) weak heart and resulting diminished pressure; 

e) acute and some forms of chronic nephritis. 
An increase in the quantity of urini occurs in 

a) diabetes insipidus [polyuria] (very marked) diabetes 
mellitus (which is rare), the daily average may be 40 liters; 

b) most forms of chronic nephritis; 

c) during reabsorption of profuse exudates and in the 
critical stage of severe infectious diseases. 

2) The color. The normal pigments in urine have not 



URINARY APPARATUS. 149 

yet been thoroughly studied; although a number of them are 
known to exist, only one has been identified, viz. urobilin which 
is a product of bilirubin and is absorbed from the intestine. 
The color of normal urine is more or less yellow, increasing in 
darkness as the amount of urine decreases, and vice versa. In 
disease the color may become lighter or darker. We distinguish : 
yellow (pale yellows light yellow, yellow), red (reddish yellow, 
yellowish red; red), and brozvn (brownish red, reddish brown, 
and blackish brown) urine. Other shades can also be recog- 
nized now and then. 

Pale, water-colored urine always occurs in polyuriaf physio- 
logical or critical polyuria, diabetes). 

Red urine is produced by admixture of blood, hemaglo- 
bin or methemaglobin. The particular cause in each case 
must be determined with the aid of the microscope. 

Greeyiish yellow ox brownish yell oiv urine or yellowish green 
foam is produced by bile-pigments. 

Dark colored urine (dark yellow or dark brown) is ob- 
served in all cases where the quantity has been reduced (con- 
centrated), but it may also be due to admixture of blood. 

Color due to medicines: carbolic acid, black; aloes and rhu- 
barb, brownish red. 

3) Transparency of urine. Normal urine of the horse is 
always turbid: even the first few drops voided; toward the end 
it becomes even more so, frequently a light clay color. The 
turbidity is due to the presence of carbonates which precipitate 
in the bladder as the fluid becomes more or less condensed 
from reabsorption processes. When exposed to the air in a 
vessel the turbidity increases because the soluble acid calcium 
carbonate (CO^ H).^ Ca after giving off C O2 + H.^ O is con- 
verted to insoluble calcium carbonate C O3 Ca. This conver- 
sion occurs most rapidly at the surface of the liquid, causing 
the formation of a thin fragile membrane at that place (crys- 
tals of calcium carbonate). Small granules of lime also pre- 
cipitate and constitute a part of the sediment. Not infre- 
quently these lime granules are imbedded in cylindrical masses 



150 CLINICAL DIAGNOSTICS. 

of mucus that were molded in the uriniferous tubules. This 
normal turbid urine has an alkaline reaction. 

Clear urine of the horse is always abnormal 
and usually has an acid reaction; upon cooling, however, it 
may become turbid. The turbidities consist of precipitated 
phosphates, oxalate of lime, and crystals of gypsum and uric 
acid salts; these dissolve upon heating the fluid. These salts 
can be recognized by means of a microscopical examination. 

Abnormal turbidity may be due to the presence of 
organized elements (cells); recognized by means of microscop- 
ical examination. 

In the ox, sheep and goat the normal urine is 
clear when voided but becomes turbid on standing; precipita- 
tion of monocarbonates. 

The urine of the dog is clear in health, becoming 
slightly turbid after standing; due to precipitation of uric acid 
salts 

4) Consistency of urine. Normal urine of the horse is a 
rather thickish, slimy, viscous fluid; the viscosity being due to 
an admixture of mucine which occurs in the bladder. Besides 
this the cast off epithelial cells undergo a process of swelling 
and thus increase the consistency of the urine. Acid horse 
urine is always less viscid than such as gives an alkaline re- 
action because the epithelial cells swell more in the former. 

All other domestic animals excrete a more watery urine. 

5) The specific gravity of urine is determined with an 
araeometer, also called urino meter when specially con- 
structed for this specific purpose. 

The specific gravity for the 

horse is 1020 — 1050, average 1040, 
ox " 1025 — 1045, " 1030, 

dog " 1020 — 1060, " 1040. 

The specific gravity varies inversely with the quantity. 
Aside from this an abnormally low specific gravity is 



URINARY APPARATUS. 151 

observed in diabetes insipidus (loo I -I o I o) and in contracted 
kidney. 

An abnormally high specific gravity is observed in 
all cases where the amount of urine secreted is below the nor- 
mal (fever) and in acute nephritis. High specific 
gravity and increased quantity is observed 
only in diabetes mellitus. 

B. Chemical Examination of the Urine. 

1) The reaction of the urine of healthy animals depends 
on the kind of food: herbivora (horse, ox, sheep, goat) secrete 
an alkaline urine, carnivora (dog, cat) secrete acid urine. In 
omnivora the reaction depends altogether on the food. 

In herbivora the alkaline reaction is due to the pres- 
ence of acid bicarbonate of lime CO.^H — Ca — CO:^H. 
The organic acid salts of lime which are contained in the food 
contain the acid radicles of malic, tartaric, succinic and lactic 
acids. These latter, upon being absorbed into the blood, be- 
come oxydized into acid carbonates which have an alkaline 
reaction. 

In carnivora acid phosphates are the cause of the 
acid reaction; PO^HgNa and (PO^H^j.^Ca; these come from 
the animal diet. Starving herbivora (hence such as live on 
their own flesh) have an acid urine. 

Except in cases like the one just mentioned an acid reac- 
tion of the urine of herbivora is always abnormal. It occurs 
when the contents of the small intestine have an acid reaction 
— intestinal catarrh. When the contents of the small intestine 
have a normal (alkaline) reaction the acid phosphates in the 
food are not absorbed, and consequently do not enter the cir- 
culation, but when the reaction is acid the opposite takes 
place, the acid phosphates are absorbed and excreted by the 
kidneys, but the organic acid salts are not absorbed. An acid 
reaction, therefore, depends on the presence of acid phosphates 
and, in case of herbivora with good appetite, points to the 
existence of intestinal catarrh. 



152 CUNICAL DIAGNOSTICS. 

Abnormal alkaline reaction of the urine of 
herbivora and carnivora occurs in the course of fermentations 
in the bladder (catarrh) and is produced by ammonia, which is 
a product of fermented urea: CO(NH2)3+2H30=C03 
(NH4)2=2NH3+C02H-H^O. This ammoniacal fermentation 
can be recognized by its odor. A glass rod dipped in hydro- 
chloric acid and held above the surface of the urine causes 
fumes to appear: NH^Cl^ Ammonium chloride. 

2) Albumin. Albumin is never a normal constituent of 
urine, i. e., in perceptible [?] amount. Its occurrence must 
always be looked upon as a symptom of disease. As a rule it 
is secreted in the kidneys, with the urine (renal albuminuria); 
in rare cases blood or other morbid products of the urinary 
tract constitute its origin (accidental albuminuria). 

The fact that normal urine contains no albumin, or at 
least no appreciable amount, is due to two factors: (i) the 
impermeability of the renal epithelial cells to albumin, (2; the 
degree of pressure exerted. When these normal condi- 
tions are altered, when the normal composition of the blood or 
the body temperature vary, albumin passes over into the 
urine. Hence renal albuminuria can occur: 

a) As a result of changes in the renal tis- 
sues due to inflammatory or degeneration processes; here we 
find not only albumin present, but the quantity of urine may 
be increased by the addition of albuminous exudate. 

b) In lowering of arterial pressure; the 
lower the pressure the easier can a diffusion of albuminous 
substances take place. Pressure is lowered in weak heart or 
in venous congestion (organic heart disease, emphysema). 
Both conditions, after existing for some time, in addition pro- 
duce changes in the renal epithelium. 

c) In fever albuminuria is always present. Several 
factors are active here. The lowered pressure may alone ac- 
count for it; the elevated temperature facilitates the process; 
continued fever produces changes in the renal epithelium. In 



URINARY APPARATUS. 



153 



case of severe infectious fevers a direct injury to the renal 
parenchyma probably occurs because in such cases the urine is 
very rich in albumin. 

d ) Mere changes in t li e normal composi- 
tion of the blood, in the absence of any change of 
blood pressure or change of structure of the kidneys, may 
bring about albuminuria (leucaemia). 

From what has been stated we can readily 
see that the mere presence of albuminuria 
does not necessarily indicate an affection of the 
fiK- ^^■ kidne3-s. 

Accidental albuminuria is rare and 
of little importance. We assiune that the albu- 
miiuiria is accidental when the filtrate contains 
large quantities of blood and pus corpuscles and 
epithelial cells and only a moderate quantity of 
albumin. In that case the proportionately small 
an:ount of albumin is supposed to result from partial 
solution of the cellular elements. 

Of the various albuminous bodies occurring in 
urine scrum alhnmiii with scruviglobuUn are most 
frequently met with; less commonly albuntoscs are 
found either alone or in company with the above. 
These latter are albuminous bodies characterized by 
the fact that boiling docs not precipitate them (pep- 
ton, propepton, hemialbumose). In a few cases we 
find hemaglobin and methemaglobin. For practical 
purposes the determination of the three groups 
mentioned is all that is necessary. 
Esbach's | Chemical determination of albuminuria. For 

Albuinmi- . r , i • i i • r . i n* 

nificT. this use freshly voided urnie; it not clear, lilter. 

1) Boiling test. Fill test tube to % its height with urine 
— if alkaline add a drop of acetic acid— boil and then add i-io its volume 
of dilute nitric acid ( s]). gr. i,i8); a permanent })recii)itate=albumin. If 
a precipitate or turbidity produced by boiling disai)])ears on addition of 
nitric acid=phos])liate of lime. 



154 



CLINICAL DIAGNOSTICS. 



2) Heller's test. The cold, filtered (and, if necessary, acidu- 
lated) urine is carefully poured on concentrated nitric acid, so as to form 
a layer on the same. If albumin is present a white or cloudy ring is 
formed in the test tube where the urine comes in contact with the nitric 
acid. 

3) Acetic acid ferro-cj-anide of potash test. To 
the filtered urine add a quantity of acetic acid and then a few drops of a 
5^ soiution of potassium ferrocyanide; the presence of albumin produces 
a white precipitate. 

If the addition of acetic acid produces cloudiness mucin is present; 
in this case filter the urine. The mucin may also be precipitated with 
acetate of lead before making the test. 

The methods here given suffice for the chemical demonstration of 
albumin. For a quantitative determination of the albumin preserve tb.e 
tubes containing the precipitate and thus the sediment, which consists of 
albumin, may be compared from day to day. For this purpose Esbach's 
albuminimeter is both simple and practical. See fig. 31. [Similar tubes 
can be obtained in the United States ] It is used as follows: Fill the 
tube with urine to the mark U (urine), then add reagents sufficient to fill 
the tube up to the mark R (reagents) as follows: 

citric acid 2.0 cc, 

pecro-nitric acid i.o cc, 

distilled water 100. occ; 
put on a stopper, shake well, and let stand 24 hours The sediment 
which consists of albumin can then be read off in fractions of 1-10$^. 
This instrument gives good results providing the amount of albumin 
present does not much exceed 0.2^; in that case dilute before testing the 
urine, say to 505^ or 2^%, by adding one <>r three volumes of water respect- 
ively; the result must then be multiplied by 2 or 4 according to tlie 
dilution. 

Albuminuria occurs: 

i) in all febrile di.seases, e.-^pecially in actite infectious 

diseases; contagious pleuro-pneumonia of the horse and in 

influenza; 

2) in acute and chronic affections of the kidneys; 

3) in venous congestion, hence in organic heart dis- 
ease, emph3sema and in the various forms of heaves; 

4) in blood diseases; leukaemia, anaemia; 

5) in nervous affections, epilepsy, eclampsia. 

II. Chemical determination of albumosuria. This has onl}' recently be- 
come of importance, since simpler methods have been found. The oc- 
currence of albumoses depends on entirely differ- 
ent conditions than those which produce albumin- 
uria. Albumosuria is not caused by inflammation of the kidneys, by 
circulation troubles nor by anaemia. Changes in the composition of the 
blood play the chief role here. Albumosuria occurs when purulent and 
fibrinous exudates are absorbed into the blood (pyogenic peptonuria) 
hence in the absorption stage of pneumonia exudates and in case of ex- 
tensive pus formation in internal organs. 



URINARY APPARATUS. 155 

Album OSes are not precipitated by boiling nor by 
acids; their presence can be definitely determined only when other 
albuminous substances (albumin, globulin, mucin) are absent. Hence 
we must first test for these; if they are present they must be precipitated 
and removed by filtration. Albumin and globulin can be preciptiated by 
"boiling the previously acidulated urine. Mucin can be precipitated with 
acetate of lead. 

The clear filtrate alone can be tested for albumoses: acidulate 500 cc 
•of urine with hydrochloric acid and then add phosphomolybdic acid 
until no further precipitate is produced. Wash the precipitate thus ob- 
tained with 5fr sulphuric acid, then with water, [this is done by filtering 
the precipitate and adding the 5^ sulphuric acid and, later on. the water 
to the precipitate in the filter.jand then subject to biuret reaction. The 
precipitate thus treated is dissolved in a weak solution of caustic soda and 
then a 10^ solution of sulphate of copper is added drop by drop; the 
presence of albuminoses produces a reddish violet coloration. 

These tests are rather troublesome to make and hence not very prac- 
tical for ordinary clinical purposes. We hope that simpler methods may 
soon become known, and then, no doubt, the detection of albumoses in 
the urine will become a more important factor in the diagno.sis of dis- 
ease. 

III. Determination of hemoglobinuria. The fact that urine 

-contaiiLS blood can often be recognized by its color alone; light 

red iirhie, resembling meat ivater (oxj^hemoglobin), is rare. 

As a rule it has a muddy brownish red color {methemoglobin) . 

A diagnosis cannot be based on the color alone, a chemical and 

microscopical examination is necessary. 

Chemical determination. Add caustic potash or .soda until the urine is 
distinctly alkaline, then boil as in albunnn test. This converts the hemo- 
globin into hematin, it is precipitated with the earthy salts and gives 
them a reddish brown color. 

The difference between oxyhemoglobin and methemoglobin mu.st 
be determined with the spectroscope. O.xyhemoglobin gives two absorp- 
tion bands between D and E, methemoglobin gives one between C and D. 

The presence of hemoglobin \\\a.y be due to admixture of 
blood as such i^hemattcrid) or to hemoglobin alone (hemo- 
globinuria). 

Hematuria is recognized by microscopic examination of the 
sediment and the detection of blood corpuscles. The admix- 
ture of blood can occur in the kidney, the pelvis of the kid- 
ney, the bladder or the urethra. It occurs most freqtiently in 
red water, acute nephritis, renal calculi, hemorrhagic infarction 
of the kidney, pyelonephritis, acute cystitis, cystic calculi. 

Hemoglobinuria consists in the presence of hemoglobin 
•(without the blood corpuscles) in the urine. The coloring 



156 CLINICAL DIAGNOSTICS. 

matter is derived either from the blood or the muscles. Ac- 
cordingly we distinguish: 

a) hematogenic or toxaeniic hemoglobinuria in redwater of 
cattle and in Texas fever, also in bad cases of poisoning which 
cause decomposition of the red corpuscles, in extensive burns 
and in the course of severe infectious diseases. 

b) myogenic or rheumatic hemoglobinuria in azoturia. 

3) Indican = indoxyl sulphate of potash Cs Hg N K S 04 
and occurs in all urine in moderate amount. It is derived from 
the indol Cs Hy N formed in the alimentary canal during putre- 
faction of albumin; indol is oxydized into indoxyl Cg Hg N. 
O H and then combines with sulphate of potash to form in- 
doxyl sulphate of potash ^^'xwdixcdin. 

If rapid putrefaction of albuminous substances takes place 
in the alimentary canal the amount of indican is increased; 
this is particularly the case in digestive disorders accompanied 
with diminished peristalsis, digestion and absorption. Consti- 
pation of the ileum pioduces the largest amount of indican; 
impaction of the colon on the other hand is attended with 
much less indican formation. 

Test for indican. Take a few cc of urine and add to it an equal vol- 
ume of hydrochloric acid; shake well, add, drop by drop, a fresh solution 
of chloride of lime or sodium hypochlorite — continuing to agitate the 
solution repeatedly; the blue colored indigo thus formed will precipitate. 
Adding chloroform and shaking the mixture thorough^, then letting 
the fluid settle, causes the indigo and chloroform to settle to the bottom 
as an intensely blue fluid. 

4) Bile pigments. Of the bile pigments bilirubin is most 
frequently found in urine; upon exposure to the air for some 
time it may be converted into biliverdin . Icteric urine is m'axx- 
zWy 6.a.x\^ co\o\&d, golden yellow, yellou'ish brown or greenish 
yellow, the foam is yellow in contrast to the normal white. 

Test. The qualitative determination is made according to Gmelin's 
test. Pour 2-3 cc of concentrated nitric acid which contains some fum- 
ing nitric acid (NO2) into a test tube, gradually adding the urine with- 
out mixing the fluids. If the urine is alkaline acidulate 
it before making the test. If bile pigments are present col- 
ored rings will appear at the point of contact of the fluids; of the colored 
rings the green alone is characteristic. 

The test for bile pigments in the urine of the horse is 



URINARY APPARATUS. 



157 



never as easy as in the urine of the dog. and in fact not as re- 
hable because horse urine always contains other (in part un- 
known) substances that influence the reaction materially. 

Normally the urine of domestic animals never con- 
tains bile pigments. They occur only in the following morbid 
conditions: 

a) retention of bile in the liver attended with its resorp- 
tion through the lymph vessels and its subsequent entrance 
into the blood; acute enlargement of the liver {hepatoircnic ic- 
terus), occlusion of the ductus choledochus in intestinal ca 
tarrh (retention icterus). 

b) in disintegration of large numbers of red blood cor- 
puscles and the formation of bile pigments from the blood 
pigments (hematogenic icterus). 

c) severe infectious diseases, extensive burns, internal 
hemorrhages. 

5) Grape sugar, b y m e a ns o r d i n a r i 1 y e m ploy - 
ed can be detected in urine in 
disease only, viz. in diabetes 
m e 1 1 i t u s . In horses this di.sease has 
been observed in a few instances only, in 
dogs it is common. We suspect the pres- 
ence of sugar in polyuria when the specific 
gravity of the urine is high. 

Chemical determination. If albumin is present 
this must first be removed bv adding acetic 
acid, boiling, and filtering. Then add to lo cc 
urine i cc caustic potash solution; if this pro- 
duces cloudiness, filter again. Then add about 3 
drops of a io;< solution of sulphate of copper. The 
appearance of a light blue color is in itself an indi- 
cation of grape sugar; now heat the fluid, if grape 
sugar is present an orange yellow precipitate which 
gradually extends downward is formed at the sur- 
face; this is an oxide of copper. 

This test (Tronimer's test) 

is by no means reliable for horse 

the latter contains other bodies that have a 




Fermentation 
tube. 

urine because 



158 



CLINICAL DIAGNOSTICS. 



reducing power: Pyrocatechin , etc. On the other hand 

substances that prevent the reduction (or precipitation) of 

oxide of copper may be present. Pure grape sugar, when 

added to horse urine, can sometimes not be detected at all 

by means of Trommer's test. In all cases of doubt we must 

therefore resort to the fermentation test, as follows: 

Boil 20 cc of urine that has been freed from albumin, let cool and add 
a piece of baker's yeast as large as a pea, shake thoroughly, pour into a 
fermentation tube and close the latter with metallic mercury. Keep 
the tube at room temperature for 24-48 hrs. If sugar is present fermen- 
tation will set in and the C Oj thus produced will collect in the top of 
the tube where the percentage is indicated by a graduated scale. 

Ce Hi 2 Oe=2Co H^ O H2+C O, 
Grape sugar=Alcohol -)- Carbondioxide 




i-- -^U' 



Carbonate of Lime. 



C. Microscopical Examination of the Urine. 

If the examination thus far conducted reveals any import- 
ant alterations, we complete the same with the microscope. A 
microscopic examination of the urine in 
diseases of the urinary organs is of even 



URINARY APPARATUS. 159 

greater importance than a chemical analy- 
sis. 

Method. Pour some of the urine into a conical glass, previously 
stirring the same with a glass rod to be sure to get an average sample. 
The urine is then set away to allow the solid particles to settle out; with 
horse urine this is a rather slow process. To prevent decomposition 
during the process of sedimentation add a few drops of chloroform. Re- 
move some of the sediment with a pipette and examine a drop on a 
slide, under the microscope. 

a. Crystalline Constituents of Urine. 

The reaction of the urine itself gives us a certain clue as 
to the character of the sediments. The normal alkaline urine 
of herbivora contains (see p. 151) carbonate of lime and 
small quantities of neutral phosphates Ca.^(P04).^. Such sed- 
iment does not dissolve when heat is applied, but the addition 
of hydrochloric acid produces solution, and development of CO.^- 
The sediment which forms in the acid urine of car nivora 
consists of acid urates and acid phosphates which dissolve on 
being heated. 

To determine accurately the nature of the crystalline sedi- 
ment a microscopical examination must be made; the forms of 
the crystals indicate their nature. Amorphous salts can be rec- 
ognized by micro-chemical tests only. 

I) Carbonate of lime crystallizes in globules with radiate 

Fig. 34. Fig. vs. 




•«^NV 




Oxalate of Lime. I'ric .A.cid. 

markings, if the globules are large a concentric marking can 
also be ob.serve:l. Carbonate of lime crystals also occur in 
form of breakfast rolls, dumb-bells, whetstones and crosses. 
Amorphous powder of carbonate of lime can be recognized by 



160 



CLINICAL DIAGNOSTICS. 



the fact that the addition of acetic acid causes an evolution of 
gas. 

2) Oxalate of lime crystallizes in square octahedra that 
have strong light-refracting power, other forms occur but are 
not characteristic. Acetic acid does not affect oxalate of lime, 
hydrochloric acid dissolves it. It occurs in small quantities in 
alkaline urine, to a greater extent in acid urine, but is of no 
importance for diagnostic purposes. 

3) Uric acid and its salts are normal constituents of the 
urine of carnivora but traces of them also occur in the urine of 
herbivora. 

Fig- 37- 





Hippuric Acid. 



Triplephosphate Crystals. 



They commonly occur as an amorphous powder or in 
the form of crystals; whetstone, rhombic plates, pointed crys- 
tals, frequently occurring in the form of minute druses. A 
characteristic consists in the peculiarity that, on crystallizing, 
they attract the pigment of the urine which gives them a 
yellowish brown color. They dissolve in a solution of caus- 
tic potash, and they are precipitated in the form of rhombic 
prisms by the addition of hydrochloric acid. 

4) Hippuric acid and its salts form rhombic quadrilateral 
prisms and needles Which dissolve in hydrochloric acid. Nor- 
mal constituent of urine of horses. 

5) Triple phosphate of ammonia and magnesia P04MgNH4 
crystallizes in coffin-lid forms, dissolves in acetic acid without 
giving off gas. Does not occur normally in freshly voided 



URINARY APPARATUS. 



161 



urine, but always forms when urine is exposed to the air for 
some 'time (fermejitatioii). If found in fresh urine it indi- 
cates that ammoniacal fermentation has taken place in the 
bladder, cystitis, pyelitis. 

6) Sulphate of lime, gypsum, occurs occasionally and in 
small quantity in the form of columnar prisms or plates in 
acid urine. It is abundant after internal administration of 
sulphates (Glauber salts). Of no importance. 

b. Organized Elements of Urine. 

In the diagnosis of diseases of the urinary organs these 
are of the greatest importance. 

1) Epithelial cells in small numbers are found in normal 
urine, occasionally we find two or three pavement epithelial 
cells in one cover glass preparation. On the other hand the 
finding of epithelial cells from the uriniferous tubules (renal 
epipthelia) is an exception under these conditions. Marked in- 
crease of epithelial cells is due to a pathological desquamation, 

Fi?. 3S. 




Sulphate of Lime, 
hence is observed in catarrhs and inflammation of the membranes 
concerned. It is important to be able to rec- 
ognize t h e o r i g i n o f t h e c e 1 1 s - b y t h e i r f o r m . 
Renal epithelium is roundish or more or less 
cubical and granulated with proportionately large granules 
and is m u c h s mailer than the pavement epithelium of 
the pelvis of the kidney, the urethra and the bladder. They 



162 CLINICAL DIAGNOSTICS. 

occur singly or several united and not infrequently show signs 
of fatty degeneration. Their occurrence indicates a renal 
affection, but whether or not inflammation exists must be de- 
termined from the rest of our examination of the urine. 

Pavement epithelia from the pelvis of the 
kidney, the urethra and the bladder resemble each other and 
cannot be distinguished as to their particular source. They 
are large, flat, polygonal, transparent, nucleated pavement 
cells. Those coming from the surface layers of the mucous 
membrane are more roundish or polygonal, those from the 
deeper layers are more oval, or cone shaped and may contain 
one or more protoplasmic projections that give them a toothed 
appearance. If a considerable number of such cells are pres- 
ent a catarrhal condition of the corresponding mucous mem- 
branes is indicated. 

2) White blood corpuscles or pus cocci are spherical, granu- 
lated, nucleated cells that are cleared or become transparent 
when treated with acetic acid. They may have come from the 
kidneys or from the urinary tract; if from the kidneys we also 
find casts, if they occur simultaneously with numerous 
pavement epithelia and crystals of triplephosphate they come 
from the bladder. 

3) Red blood corpuscles, when found in the urine, have lost 
most of their coloring matter, are pale and swollen. Those 
coming from the upper portions of the urinary tract have 
undergone these changes to a greater extent than those com- 
ing from the lower portions. Thorough admixture of red cor- 
puscles with the urine, thus retarding sedimentation of the 
former, points to renal hemorrhage; blood casts always point to 
renal hemorrhage. Large masses or clots of blood, not thor- 
oughly mixed with the urine, come from the bladder. An 
admixture of blood with the urine (hematuria) occurs in: 

a) diseases of the kidneys: injuries, hem- 
orrhagic nephritis, embolic nephritis; 

b) diseases of the urinary tract : pyelonephritis, cystitis, 



URINARY APPARATUS. 



163 



red water of cattle, cystic calculi, cystic tumors, injuries of 
the urethra. 

4) Urinary casts are cylindrical bodies that were molded in 
the lumen of the uriniferous tubules. In the urine of the 
horse we find similar structures under ncrmal conditions; they 
consist of strings of mucus of variable thickness, sometimes 
macroscopically visible and granulated with deposits of amor- 
phous carbonate of lime. Addition of acetic acid causes the 
granules to disappear with the formation of CO^. In acid 
urine we find uric acid salts instead. These so called granule 
casts, lime casts, or cylinderoids have nothing whatever 
in common with true urinary casts. They are especially com- 
mon in the transition stage from oliguria to polyuria. 

The true urinary casts are distinguished as follows : 

a) Hyaline casts, slender, transparent, homogeneous 
bodies of various sizes and not sharply defined contour. 
The}^ are rare, occur in health as well as in disease, are of no 
diagnostic importance and their origin is unknown. 

I'i.y- 39- b) Epithelial casts consist of renal epithelia 

agglutinated with exudates and forced out of the 
tubules by the pressure of the 
urine above them. Frequently 
red and white blood corpuscles 
are associated with them. Such 
cylinders, providing they occur in 
any appreciable numbers, always 
indicate inflammation of the kid- 
neys. These epithelial cells may 
also have undergone fatty degen- 
eration. If they contain no cells 
they are called gramdar casts, 
and have the same significance as the epithelial cylinders. 

c) Blood corpuscle casts are formed of agglutinated red 
corpuscles and are due to renal hemorrhage. If these casts 





Epithelial 
Casts. 



Granular Lasts. 



164 CLINICAL DIAGNOSTICS. 

contain many white corpuscles they indicate purulent inflam- 
mation { pus-casts). 

5) Examination for micro-organisms is of value in case 
of fresh urine onl}-, because urine that has been standing for 
some time will soon become filled with great masses of bacteria 
and mold fungi from the air. Large numbers of bacteria in 
fresh 2irine occur in pyelonephritis bacteritica and in chronic 
cystitis. 

Bacillus pyelonephritis bovis will stain according to Gram's method. A 
cover glass preparation is made from the sediment of the urine, stained 
with gentian violet, rinsed with water, a few drops of Lugol's solution 
(lod. 8, Pot. lod. 4, Aqua loo) added, then decolorized in alcohol. All 
bacteria that stain according to Gram's method have now assumed a deep 
blue color; while all the rest are decolorized. Bac. pyeloneph. appears as 
a rod with rounded ends, 2-3// long and o.j/i in diameter, evenly stained 
and usually occurring in little groups. 

ill. Examination of the Urinary Organs. 

Topography. In the horse and cow the left kidney only 
is accessible for palpatio ii from the rectum, the 
right kidney lies further for^vard and cannot be reached by the hand. In 
the horse the left kidney extends back to about four inches behind the 
last rib and its inner border is separated from the median line by about 
the same distance. In the ox it is loosely suspended below the 
lateral processes of the first lumbar vertebrae. Sometimes it may be 
shifted over to the right side. In the dog the kidneys lie in the lumbar 
region, the right somewhat more anterior than the left; hence the left 
kidney can be more easily felt from the outside than the right kidney. 

In palpating the kidneys follow the general 
rules for this method of examination (see p. 2 1 ) . In pyeloneph- 
ritis of the ox the kidneys are enlarged and firm, the ureters 
distended and their walls thickened and firm. 

Examination of the bladder, per rectum, in 
the horse and ox, is quite practicable; in the dog the examina- 
tion must be made by external palpation. The extent to which 
the bladder is filled is of importance; if empty, in the horse 
and cow, it represents a soft pearshaped body lying on the floor 
of the pelvis. If well filled it can be felt as a distended body 
projecting far beyond the anterior border of the pelvis. To 
feel it the hand need not be inserted much further than to the 
wrist. The contents of the bladder can be removed by a steady 



URINARY APPARATUS. 165 

hut moderate pressure applied with the hand, or by means of 
the catheter; this may be important to determine whether 
evacuation is possible. If the bladder is ruptured, which is 
most common in oxen with urethral calculi, it is permanently 
small and flabby. 

Cystic calculi and tumors in the bladder can be recognized 
with certainty only when this organ contains little or no fluid 
contents. 

Examination of t h e u r e t b r a is of consequence 
in male animals, particularly in oxen, when the presence of 
calculi may be suspected. As a rule these are lodged in the up- 
per or lower portion of the S shaped curve. Pressure exerted 
at the point where the obstruction is located produces pain. 
As long as the bladder is not ruptured urine may dribble from 
the distended urethra. Unfortunately catheterization is impos- 
sible in the ox (sharp curves and narrow lumen of urethra); 
in the horse and dog this examination is easy and reliable. 

Diseases of the Urinary Apparatus. 

Passive hyperaemia of the kidneys occurs as a result of chronic heart and 
lun<i trou])les. Urine is decreased, sp. j<r. increased, albumin present. 
Symptoms more cons])icuous after exertions. 

Acute diffuse nephriti<. This is primary only in cases of poisoning with 
irritatini^ substances, otherwise it is a symptom of severe infections. Dys- 
uria, strantjuria, pain in the rej^ion of the kidneys, stiff K^it and crooked 
back. Consideral)le diminution of renal secretion (anuria), thick and 
viscid, turbid, hii^h sp. j^r., acid, much albumin. Microsco])ic examina- 
tion most important: ,<,rranular casts, renal eiMthelia and blood corpu.scles. 
Stupefaction, difficult brcathinjj, ciedematous swellin.t^s. 

Nephritis suppurativa. Secondary afTection ami u-iually of le.-;s impor- 
tance than the ])rimary disease. Intermittent fever, exhaustion, emacia- 
tion, urine contains ail)umin, pus corpuscles and micro-organisms. 

Chronic nephritis. No fever, develops very slowly. Anorexia, exhaus- 
tion, emaciation. Pulse stron,g and hard, heart hyiJertrojihied. Increased 
amount of urine, low .sp. gr., amount of albumin .sli,<,'ht. few ejnthelial 
cells and casts. 

Cystitis, inflammation of the bladder. Continuous efforts to urinate, 
hence small cjuantities or only a few drops are voided at a time. Urina- 
tion painful, restlessness, jrroanini,', animals remain for a Ions,' tinie in a 
"urinatint,' attitude." Urine cloudy, alkaline, slimy or ]nirulenl ,se<liment, 
ammoniacal odor. Pus corpuscles', red blood corjniscles, numerous pave- 
ment epithelia, phosphate of ammonia and nuij^ncsia. 

Retentio urina. Retention of urine. Complete (ischuria) or partial 
suppre.s.sion of urination; in the latter case it is voided in drojis and with 



166 CLINICAL DIAGNOSTICS. 

symptoms of pain. Palpation of the bladder very important : distention,, 
pain on pressure. Animals indisposed, inactive, do not lie down, appetite 
diminished, pulse increased, sv^'eating. After rupture of bladder has oc- 
curred the pains disappear, animals feel more at ease, bladder is empty. 
Then come chills, high fever, urinous odor of transpired air. 

Incontinentia urinx. Paralj-sis of bladder. Involuntary flow of urine, 
especially during motion. 

Hematuria is a chronic productive cystitis of the ox, with tendency to 
hemorrhage. Blood corpuscles and clots in the urine. 

Hemoglobinuria of the ox. Hemoglobinsemia. Fever, partial loss of 
appetite, diarrhoea. Urine light red to dark red, foams readily, urination 
painful, reaction at first acid, later on alkaline, contains hemoglobin, on 
boiling coagulates as gelatinous mass. 

Pyelonephritis bacteritica bourn. This is a chronic purulent inflamma- 
tion of the ureters and pelvis of the kidney's which spreads to the kidneys 
and is caused by a specific bacillus. Gradual emaciation and general 
depression. Intermittent fever. Urine thick and slimy, cloud}-, gray or 
grayish brown, white and red blood corpuscles, casts, numerous pavement 
epithelia, cr3'stals of triple phosphate, and bacilli, Bacillus pyelonephri- 
tidis boum. Stain according to Gram, 2-2,11 long, 0.6-0.7^ in diameter, non 
motile, straight or slightly bent, rounded at the ends. 

Diseases of Tissue Metabolism. 

Diabetes insipidus, polyuria, pissing, is an independent disease in which 
large quantities of clear watery urine are passed continuously. Daily 
quantit}^ of urine passed=as high as 30 liters. Urine as clear as water 
or slightly yellow, acid, sp. gr. looi-ioio, no albumin, little indican. 
Diminished appetite, desire for alkalies, [earth etc.] emaciation. 

Diabetes meliitus, sugar in the urine, is very rare in horses, more com- 
mon in dogs. Polyuria, ravenous appetite and thirst, rapid emaciation. 
Urine has high sp. gr., 1024-1045, and contains grape sugar. 

10. The Sexual Apparatus. 

Most of the organs of the sexital apparatus may, for 
the greater part, be subjected to direct inspection and 
palpation; their examination should be conducted according 
to general rules, care being observed that no parts are over- 
looked. For natural reasons the female sexual organs are 
more frequently affected with disease than those of the male.. 
Most of these diseases belong to the field of obstetrics. 

I. Abnormally increased sexual desire manifests itself not only 
by sexual excitement but also by psychic disturbances and 
altered sensibility, these often resembling diseases of the cen- 
tral nervous system. In females this condition is known as 
nymphomania, in males as satyriasis; continued erections of 
the penis is c?i\\e6. priapism. 



SEXUAL APPARATUS, 167 

Mares are usually very ticklish and easily excited, if 
touched with the hand or harness they squeak or cry out, 
switch their tail, back up against persons or against the wagon 
tongue, kick, urinate, and can be used for their regular work 
only when special care is exercised. In rare cases they may 
act like dummies (general depression of the sensorium) and 
show symptoms of hyperaesthesia. 

C o w s show symptoms of great restlessness, are very ex- 
citable, bellow frequently, attack strangers, etc. Milk secre- 
tion is reduced, the milk has a bad taste and sometimes curdles 
when boiled. 

In horses and bulls satyriasis manifests itself by 
restlessness and excitable, sometimes vicious, actions. 

In many cases the cause of these conditions cannot be as- 
certained; in cows tuberculosis of the ovaries, in horses cryp- 
torchism, is often the cause. 

A. Female Sexual Organs. 

II. The vulva. In bitches we observe swelling of the vulva and a bloody 
mucous discharge at the oestral period. In cows a tough glassy mucus is 
discharged just before parturition. This mucus comes from the neck of 
the uterus which it served to close. • 

A slight swelling of the vulva occurs in vesicular eruption 
of this region; small vesicles the size of a millet seed, and 
swelling may also occur in the adjacent skin in this condition. 
In puerperal septicaemia the vulva swells conspicuously. 

In torsion of the uterus the vulva is retracted and 
drawn into folds; however, exploration per vagina is 
necessary to definitely determine this condition. 

Discharge from the inferior commissure 
of the vulva and soiling of the surrounding skin and tail 
are observed in : 

a) catarrh of the vagina and uterus. In chronic catarrh 
(fluor albus) the discharge is of a thick slimy character and 
glassy; in acute catarrh the discharge is of a thin slimy 
character and discolored. 

b) retention of the afterbirth; an ill smelling, discolored 



168 CLINICAL DIAGNOSTICS. 

fluid mixed with fragments of the foetal membranes is dis- 
charged. 

c) vesicular eruption; the discharge is slight, slimy or 
purulent, sometimes mixed with blood. 

d) tuberculosis; slight, chronic, muco-puruleut discharge 
containing tubercle bacilli. 

III. Vaginal mucous membrane. Whenever there is discharge 
from the vagina the vaginal mucous membrane should be ex- 
amined. 

Method. Grasp the tail near its root, raise it well up, and let it rest 
on the back of the other hand thus leaving the fingers of that hand free 
to open the lips of the vulva. In order to examine deeper lying parts an 
assistant should hold the tail and the operator can then insert his whole 
hand, which must be previously covered with oil. After thorough palpa- 
tion in this manner the other hand may al.so be inserted, the vaginal walls 
spreail apart, and their mucous membrane inspected; here artificial light 
may be of advantage. A vaginal speculum is not absolutely necessary 
for these examinations. 

By means of direct examinations like these, affections of 
the vagina can best be observed and their character deter- 
mined. In vesicular eruption yellowish gray nod- 
ules, vesicles or ulcers, the size of a millet seed, are found on 
the slightlj' and diffusely reddened mucous membrane. After 
healing, light specks that indicate the position of former vesi- 
cles and ulcers can be observed for some time. 

In torsion of the uterus the vagina is contracted 
and the mucous membrane is drawn into twisted folds. The 
examination of the uterus and the explanation of changes in 
that organ belongs to the field of obstetrics. 

IV. The udder. In the examination of cows 
the udder must never be neglected. Inquire 

at least as to quantity and quality of the milk. Ob- 
serve the color of the skin and note any changes that may 
have taken place. The teats of cows and sheep may be 
affected with pox, in foot and mouth disease the teats of cows 
may be covered with blisters; we also find milk fistulse. 
Observe also the relative size of the different quarters of the 
udder and the condition of the surface; note the size, position, 



SEXUAL APPARATUS. 



169 



and direction of the teats. In palpation each quarter 
should be separately felt, its size and consistency noted and 
sensitive or knotted areas observed. The teats 
should be soft and the milk canal should not be felt; 
if thickenings or swellings exist, their location, extent, size and 
form should be determined. Finally, milk every teat in order 
to determine the ease with which the fluid can be drawn, notice 
the size of the stream and the character of the milk, whether it 
is clotted or bloody: A micro- 
scopical examination of abnormal 
milk is not necessary but may be 
of value in some cases. To deter- 
mme whether a cow is "fresh" a 
microscopical examination of the 
milk for the colostrum bodies or cor- 
puscles must be made. 




oO, 

ColosUal Milk. 



B. M a 1 e S e X u a 1 Organs. 

V. Diseases of the male sexual organs are usually of a surgical 
nature. In vesicular eruption we find vesicles, pustules and 
ulcers, or scars, on the penis. To examine stallions or bulls 
they may be lead up to a mare (or cow) which usually results 
in voluntary protrusion of the organ. In ])ulls manipulation 
with the hand may answer the same purpose. In glanders the 
testicles may reveal the presence of knots. 

Diseases of the Sexual Organs. 

Torsio uteri, torsion of the wonih, of interest in internal medicine 
only when parturition or pregnancy is excluded. Animals are restless, 
kick belly with hind feet and have pains of labor. Examination of 
vagina gives necessary information. 

Vaginitis (colpitis), inflammation of vagina. Symptoms vary much, 
according to degree and character of the affection. If inflammation is 
severe, general health is affected. Animals make frequent attempts to 
urinate; small quantities of urine passed at a time; animals remain long 
in a "urinating attitude." E.xamination of vagina gives necessary in- 
formation. 

Endometritis, inflammation of the womb. Follows parturition; intensity 
of disease varies. General health more or less disturbed, fever, dis- 
charge from vagina which varies according to character of inflammation, 



170 CI.INICAL DIAGNOSTICS. 

is observed particularly when animals lie down. Soiled tail, examination 
of womb according to general rules of obstetrics is always indicated. 

Mastitis, inflammation of udder, garget. 

i) Mastitis interstitialis. Fever and hot, rather firm 
and painful swelling of udder. Quantity of milk decreased, quality not 
affected. 

2) Mastitis catarrhalis. Udder evenly enlarged, soft and 
elastic, hot. Teats swollen, hot, sometimes reddened. Milk resembling 
whey. Fever, loss of appetite. Infectious catarrhal mastitis is a special 
form of catarrhal mastitis, infectious, milk yellowish. Usually all four 
quarters affected. 

3) Mastitis parenchymatosa. As a rule only one quar- 
ter affected. Fever, appetite diminished, rumination interrupted, con- 
stipation. One quarter of the udder enlarged, firm, hot, sensitive. The 
teat of the affected udder is usually free from inflammatory symptoms, 
the milk secretion is greatly decreased, yellowish, contains muco-puru- 
lent flakes which usually contain numerous streptococci. 

4) Mastitis tuberculosa, A few nodular enlargements, 
otherwise the udder is tough and flabby. Supramammary 
glands enlarged. Tubercle bacilli in milk. 

Vesicular eruption [coital exanthemae] is an acute infectious vesicular 
exanthema of the mucous membrane of the vagina and the penis. Peri- 
od of incubation 3-6 days. The vesicles develop into little ulcers. 

Mai du coit [seen in U. S. in imported stallions]. Period of incuba- 
tion 8 days to 2 months. Swelling of the vulva and penis, formation of 
vesicles and ulcers. Frequent attempts to urinate, increased sexual de- 
sire, urticariform swellings of skin, paralysis of hind parts. 

11. The Nervous System. 

Diseases of the central nervous system can be recognized only 
by the disturbed functions of its parts, a physical examination of 
the diseased parts is out of the question. We must therefore 
subject each function to a careful examination and draw con- 
clusions as to the parts affected from the character of the dis- 
turbed physiological processes and conditions. To diagnose 
diseases of the central nervous systeiii requires a knowledge 
of the location of the principal functions. 

Preliminary remarks on anatomy and physiology. All efferent (motor) 
psychic (conscious and volitional) fibres originate in the cortex of the 
cerebrum, and all sensory fibres and fibres of special sense that conduct 
perceptibl e impulses terminate in the cortex of the cerebrum. The 
voluntary motor fibres (psycho-motor or cortico-muscular tracts, or sim- 
ply pyramidal tracts) course from the cortex, through the pons 
Varolii to the anterior pyramids of the medulla oblongata. Here most of 
these fibres cross over to the opposite side (motor decussation) and go to 
the motor nerves of the extremities, through the lateral columns of the 
spinal cord. A few fibres that do not decussate as above described course 
along the anterior columns of the spinal cord and gradually pass over to 



. NERVOUS SYSTEM. iTl 

the other side like the rest but through the white coiuuiissure along the 
course of the cord. 

Hence destructive processes in one hemisphere 
result in motor and sensory paralysis on the oppo- 
site side of the body. 

The cerebral hemispheres are also the seat of all psychical activities; 
they are the seat of thought, volition, and sensation' INIany motor 
centers are also found in the cerebral cortex and hence innammatory 
conditionsof this region may be attended with convulsive movements of 
the muscles. 

The midbrain (crura cerebri, corpora ciuadrigemini and optic thalami ) 
is the seat of the entire mechanism, harmony and equilibrium of all 
motions. Animals with both hemispheres removed, but with the mid- 
brain intact can retain their equilibrium under the most varied condi- 
tions- Inflammatory irritation of the midbrain produces involuntary 
movements. 

The cerebellum harmonizes or co ordinates the movements of the body 
by regulating the succession of muscular contractions. 

The spinal cord, besides conducting impulses to and from tlie brain, 
contains reflex centers which, when stimulated by afferent impulses, 
cause certain kinds of important movements (defense, flight, etc.). 
These movements are carried out independent of anv action on part of 
the brain, as is easily proved on decapitated animals or where the spinal 
cord has been cut through. The thus isolated cord is as prompt as ever 
in producing reflex actions. The lumbar cord is the special center for 
defecation and urination, which also depend on reflex activity. 

To be able to recognize normal conditions a.s well as to 

determine the presence and seat of pathological changes in the 

central nervotis system observe the following points : 

I. Psychic Functions. 

II. S e u s i b i 1 i t y . 

III. Motility. 

I. Psychic functions. Since the cerebrum and particularly 
its cortex is the seat of all p.sychic activities, disea.se of the 
same must interfere with normal thouo;ht, fedino, and volition; 
movements, .sensations and perceptions of peripheral parts 
occur unconsciously. The general mechanism, harmony and 
equilibrium of mu.sciilar movements may be entirely intact in 
this condition. Mental disturbances occur in a great many 
infectious di.scases, in febrile diseases in general, in the course 
of intoxications (poi.sonings) of varied kinds, and in local dis- 
eases of the brain it.self. 

Therefore, mental disturbances can be 
ascribed to local causes only when the possi- 



172 CLINICAL DIAGNOSTICS. 

bility of a general cause is eliminated. The 
disturbances in question consist of abnormal excitability or of 
abnormal depression . 

Mental excitement is the result of cerebral irrita- 
tion— as observed in acute cerebritis. Horses become restless, 
neigh, refuse to be lead, try to tear loose from the halter, step 
to and fro, paw, climb up into the manger, are anxious and 
easily frightened. Cattle bellow, snort, shake their heads, 
jump around, and into the manger. Dogs manifest their rest- 
lessness by an aimless running about, barking, howling 
and even biting. Pigs squeal, crawl under the litter, run 
about, climb over obstacles and jump up against walls. Similar 
symptoms are also observed in rabies, acute tubercular menin- 
gitis, malignant catarrhal fever of the ox and in anthrax. 

Symptoms of mental depression frequently 
follow those of excitement. The animals droop the head, 
rest it on the crib or feeding rack, eyes half closed, take no 
interest in their surroundings, do not recognize familiar per- 
sons, run against obstacles, etc. In feeding they grab the food 
with the incisor teeth, chew slowly and "languidly," stop 
without a motive when food is still in the mouth and between 
the lips. In drinking they plunge their mouth into the water 
and often "chew" it. It is hard to make them move, they 
step around clumsily, wont "get over" when commanded to 
do so; they are hard to guide when driven, try to stay over on 
one side; if badly affected they cannot be used for service be- 
cause they do not recognize commands. According to the de- 
gree of mental depression we recognize : 

Dullness; 

Somnolency, sleepiness, drowsiness, from which the patient 
is easily roused. 

Sopor, profound sleep, rousing difficult. 

Coma, profound insensibility. 

A dulling of the psychic functions occurs in; 

i) all acute infectious diseases: contagious pleuro-pneu- 



NKRVOUS SYSTEM. 173 

monia, influenza, Rinderpest, anthrax, horse distemper, dog 
distemper, septicccmia, Rothlauf of swine, etc.; 

2) all severe febrile diseases; 

3) chronic affections of the brain : blind staggers, turn- 
sick of sheep, second stage of acute cerebritis and cerebral 
hyperaemia; 

4) poi.soning with narcotics; 

5) icterus, uraemia; 

6) chronic gastric and intestinal affections of the horse. 

Dizziness (vertigo) and syncope (fainting) are suddenly occur- 
ring temporary disturbances of consciousness and loss of 
equilibrium. Animals suddenly become unsteady in gait or 
standing position, sway, reel, stagger and sometimes fall to the 
ground. The cause may consist of the presence of parasites in 
the brain, hemorrhages, tumors, abscesses, passive cerebral 
hyperaemia (compression of jugulars by harness), aortic insuf- 
ficiency or stenosis, also the action of glaring light ("ocular 
vertigo"), irritations of the external auditory meatus, and of 
the nasal mucous membrane by parasites, finally also of 
poisoning with certain plants. 

II. Sensibility. The sensibility is tested by artificial stimu- 
lation, sticking a finger into the ear, flipping the nose with the 
finger, stepping on the coronet, pin pricks. In testing the 
general sensibility observe that no inflammatory condition ex- 
ists in the part "tested." Peripheral irritation may give rise 
to spinal reflex actions, e. g. the hoof may be raised without 
any consciousness of the act on part of the animal either as to 
the act or stimulus producing it. For this reason the 
general b e h a \' i o, r of the whole animal must 
be taken into account in testing its sensi- 
bility. If dogs cry out during such ane.xaniinatiou, or t es t 
we may conclude that conscious feeling exists. 

Decreased se?isi'd///h' {<, ca.]\ed /lypaeslhesia, absence of sen- 
sibility is called anaesthesia, abnormally increased sensibility is 
called hyperaesthesia. Sometimes .sensibility is retarded; this is 



174 CLINICAL DIAGNOSTICS. 

indicated when the reaction occurs an unusuall}^ long time after 
the stimulus is applied. 

Hyperaesthesia is most frequently seen in old 
ticklish mares, also in lumbar prurigo of sheep and in the 
first stages of cerebritis. 

Diminished sensibilit}' is observed in chronic aflfections of 
the brain, immobility, tumors, second stage of acute cerebritis, 
parturient fever, second stage of cerebrospinal meningitis, and 
in narcotic poisonings. 

III. Motility. In morbid conditions affecting the cerebral 
hemispheres only we observe no serious disturbances in mo- 
tility because the mid brain and the cerebellum are the seat of 
co-ordinated movements. 

Spasms, or cramps, are involuntary muscular contractions. 
Spasms of short duration, alternating with relaxations, are 
called clonic spasms; if the}' are very slight, uniform, rapid, 
and locally limited we call it trc^nbling, if they affect large 
areas or extend over the whole body we call them convul- 
sions. Clonic spasms are observed in partial and general epi- 
lepsy and in inflammatory affections of the brain and spinal 
cord (common after dog distemper). Tonic or tetanic spasms 
are muscular contractions that continue for some time without re- 
laxation. They are characteristic for tetanus (lock-jaw) and 
strychnine poisoning, causing the body to[^assume a stiff posi- 
tion, especially the head, neck, ears, back, and tail. The mouth 
is closed as a result of contraction of masseter muscles, nos- 
trils distended "trumpet like." Stiffness of the back without 
bending is called orthotonus, depression of spinal column and 
bending back of head toward withers, opisthotonus, spasms of 
the masseter muscles, trismus, spa.'^ms of the extensors of 
the limb, sazvhorse attitude, muscles of the ej'e, prolapsus of the 
-nietnbrana nictitans, cramps of facial mucles, risus sardonicus 
(canine laugh). Tonic spasms in connection with clonic spasms 
are also observed in cerebro-spinal meningitis i^cravip of the neck'). 

All spasms have their origin in the cortex of the cerebrum, 
the pyramidal tracts, or in the anterior cornua of the spinal cord. 



NERVOUS SYSTEM. 175 

Spasms originating^ in the cerebrum are attended with mental 
disturbances (epilepsy), not so in case of spinal spasms. 

Reflex spasms are due to irritation of peripheral sensory 
nerve endings and are of spinal origin ; they are observed when 
animal parasites occur in the intestines, during the period of 
shedding teeth, and in painful gastric and intestinal affections. 

Involuntary movements may be due to irritation of one of the 
cerebral hemispheres or to paralysis of the opposite one, also 
to affections of the midbrain or of the cerebellum. They al- 
ways proceed from circumscribed lesions and are therefore 
known as "symptoms of local origin." Sometimes involun- 
tary movements occur in the muscles t. f the body and extrem- 
ities, or the usual voluntary movements assume an involun- 
tary character. In such cases animals manifest a desire to 
"go ahead," trot with head raised or lourred, run against ob- 
stacles; if they get into a corner they are at a loss as to how to 
get out, frequently the}' fall down in such a case. Sometimes, 
but more rarely, they ci'allc baekzvards. If the cerebral disturb- 
ances are unilateral the symptoms tend to be the same. The 
animals walk in a circle {Rcitbah)ibewegungen, riding sehool 
movements:) they lie down and roll, turning on their long axis, 
or they fix their hind feet as a pivot, and walk around with 
their forefeet — move like the hands of a eloek. Involuntar}' 
movements are most frequently observed in chronic and acute 
hydrocephalus, abscesses, hemorrhages, tumors and parasites 
in the brain. Turn sickness, [gid] , of sheep is thus charac- 
terized. 

In so called r i d i n j^ school and clock hand movement 
the coenurus is usually located on the surface of that half of the cerebral 
hemisphere facinjr the center of the circle; spmetinies on the optic thal- 
amus of the o])])osite side. 

If affected shee]) move forward with the head down and trotting 
motion of the forelimbs ( trotters) the seat of the parasite is at the an- 
terior end of the hemisi>here or on one of the cor])ora striata. 

Staggering gait, reeling, dizziness \staggerers.) indicate that the para- 
site is located in or on the cerebellum. 

When the coenurus is located at the base of the cerebellum it causes 
rolli)iii^ movements of the animal. 

If the animals hold their heads uj) high or backwards and move for- 



176 CLINICAL DIAGNOSTICS. 

ward rapidly, fall down, (sailors) the coenurus is located in the poste- 
rior portion of the cerebrum. 

Disturbances of the muscular sense. The muscular sense ena- 
bles us to recognize the position of the limbs and the extent of 
passive and active movements. As long as equilibrium is not 
afifected, an animal suffering from disease of the cerebrum can 
be made to assume unphysiologic positions without being con- 
scious of it, in fact the}^ do this themselves, they interrupt 
movements before they are completed or go to the opposite ex- 
treme and make more extensive movements than occur nor- 
mally. 

In acute cerebritis and staggers horses sometimes assume 
peculiar positions of the legs, cross them, set them close to- 
gether or one before the other; one may be set unduly forward, 
the other unduly under the body. When such positions are 
produced passively the animals make no attempts to change 
them. In moving about they raise their legs unusually high, 
(groping, wading walk) or not high enough and thus stumble 
when they meet obstacles. 

Paralyses consist in partial or complete loss of power to 
bring about muscular contractions. Ccmiplete inability to 
move is called complete paralysis, if there is simply dimin- 
ished power to produce movements we call it incomplete pa)-- 
alvsis {px)esis). According to the origin of the paralysis we 
distinguish (-6vr<5;7?/, spinal, ^nd periphci-al paralyses. Paraly- 
sis of one side of the body is called hemiplegia, of both sides 
(both hind legs) paraplegia; paralysis of a single organ or 
part is known as monoplegia. Hemiplegia have their origin in the 
brain, paraplegia in the spinal cord, monoplegia in the motor 
centers of the brain or, and as a rule, in peripheral nerves. 

In cerebral paralyses the cranial nerves are 
frequently also affected and psychic disturbances are present; 
we observ^e cerebral paralyses in ; 

i) braiu diseases: acute cerebritis, cerebro- spinal menin- 
gitis, abscesses, hemorrhages (apoplexies), tumors, parasites. 

2) infectious diseases: rabies, mal du coit (always), ex- 



NERVOUS SYSTEINI. 



17T 



ceptionally in horse distemper, and in contagious pleuro-pneu- 
monia of the horse; 

1,) in intoxication diseases: parturient fever, mycotic 
intoxications, brine poisoning. 

Spinal paralyses are usually paraplegia which 
affect all nerves beyond the point of injury or disease and are ^ 
always attended with sensory paralysis. Psychic disturbances * 
are wanting. They are caused by : 

i) spinal fractures; 

2) diseases of the cord: inflammation, hemorrhage, 
tumors, parasites; 

3) infectious diseases: dog distemper, rabies, rarely in 
contagious pleuro-pneumonia of the horse. 

Spinal paralyses aUo affect the vegeta- 
tive branch of the nervous system, since the 
lumbar cord is the center for the production of the contractions 
that produce defecation and urination. Hence paralysis of the 
rectum and bladder with the inevitable results (im- 
paction of rectum and distention of bladder with urine) 
occurs. See pp. /?7 ond i/S. 

Peripheral paralyses are for the most part of a 
surgical interest. In internal medicine paralysis of the facial 
nerve, because it interrupts normal feeding, and paralysis of 
the recurrent nerve, because it disturbs respiration, are of inter- 
est. These two morbid conditions have been considered more 
in detail elsewhere. 

Reflex excitability. Reflex movement is a temporary muscu- 
lar contraction brought about by stimulating a peripheral (sen- 
sory) nerve ending. In order that reflex movement may 
occur the sensory and motor nerve fibres and the reflex center 
must be intact. Reflex movement is limited to one muscle or 
muscle group {s/mp/c rcfJex) or\i may affect the whole body 
and in that case may be inco-ordinated ( reflex spasm ) or co-or- 
dinated {motions 0/ defense or flight). The following physiolog- 
ical reflexes are of clinical importance: 



178 CLINICAL DIAGNOSTICS. 

a. Reflexes of the brain. 
i) Closing of the eyelids. The sensory fibres 
(trigeminus) of the cornea, conjunctiva and of the skin in the 
neighborhood of the eye conduct impulses to the medulla ob- 
longata and from that point the facial nerve produces contrac- 
tion of the orbicularis of the eyelids. 

2) Sensitiveness to light on part of the 
pupil. Increased reflex excitability occurs 
in tetanus and in strychnine poisoning. Contracted pupil is 
observed in morphine, eserine, and pilocarpine poisoning. 

Decreased reflex excitability in great men- 
tal depression, excessive pain and in dyspnoea of high degree. 

Dilated pupil {mydriasis) occurs in paraly.'-is of the 
optic nerve (black cataract) and in paralysis of the oculo 
motor nerve (atropin poisoning). 

b. Spinal reflexes. 

3) Skin and tendon reflexes con^-i^t of short 
contractions (raising of leg) produced by striking the skin, 
tendons or bones : cannon bones, fle.xor of the carpus, inferior 
patellar ligaments, Achilles tendon. 

4) Reflex centers for defecation and uri- 
nation. See pp. 171 and 177. Disturbances of these 
centers occur in diseases of the spinal cord. 

Dis.trases of the Nervous 5ystem. 

Cerebral congestion. Hypersemia of short duration, fluctuating in 
-character and enlirely c-urdble. Begii.s with stage of excitement; ani- 
mals are rcfstless try to force themselves forward or sideways, rear, 
kick, shake their heads, walk backwards, tear the halter strap, etc. 
After a few hours the stage of depression sets in: animals are stupefied, 
sad look of the eye, head down, disregard familiar commands. 

Acute inflamation of the brain, acute hydrocephalus. Differs from con- 
gestion in its more pronounced s^-mptoms and its longer duration. In 
the second stage (that of depression) we observe abnormal attitudes and 
movements, staggering, sometimes falling down and inability to get up 
again, sometimes attacks of raving madness. Temperature frequently 
increased, but fever may be absent. Feeding alwaj-s more or less inter- 
rupted, especially the viavner oi feeding. 

Blind Staggers. Morosis equorum. Hvdrocephalus chronicus. This is 
a chronic apyretic incurable affection of the cerebrum which manifests 
itself by mental disturbances, and by impaired locomotion and sensibil- 



NERVOUS SYSTEM. 179 

ity. Pulse stronj^ and full, number of heart beats never increased, but 
frequently diminished — a very constant sympt'in. Appetite usually 
good but animal eats slowly. Ability to work present to a limited 
degree. Examination for staggers. See p. i8o. 

Epilepsy. 'Falling sickness" is a chronic disease of the brain char- 
acterized by paroxysms occurring at intervals and attended by sudden 
loss of consciousness and disturbed sensibility. 

Dizziness, vertigo. This is a primary disease, occurring at intervals, 
characterized by interrupted equilibrium and due to circulatory disturb- 
ances in the brain. 

Cerebral hemorfhage. Apoplexy. Sudden dizziness, involuntary move- 
ments, loss of consciousness, falling down, paralysis (hemiplegia and 
monoplccjia ). 

Ecldmpsia is an acute epilepsy, ending in recoverv or in death. 

Turnsick is a disease of sheep caused by the presence of the larval 
form of Taenia coenurus in the brain, ist stage cereljral excitement, 
2nd stage-latent stage, 3rd stage is that of turnsick, characterized by 
symptoms of local brain affections. 

Paralysis of the facial nerve. In case of peripheral paralysis the cheeks, 
lips and nasal muscles are paralysed, usualh- unilaterally; if paralysis is 
bilateral we have dyspnoea and difticulty in feeding. In case of cen- 
tral paralysis the upper eyelids droop, eyes cannot be closed and the 
auricular muscles are aflfected. 

Lumbar prurigo of sheep is a chronic, hereditary affection of the 
spinal cord characterized by hyperaesthesia, weakness and paralysis of 
the hind parts and by progressive emaciation, invariably leads to death. 

Infectious Diseases with Localization in the 
Central Nervous System. 

Lockjaw, tetanus, is an intoxication produced by the entrance of the 
products of the tetanus bacilli into the blood. Spasmodic condition of 
^ the entire skeletal muscles, animal is stiff, eyes retracted, membrana 
nictitans prolapsed, head and neck bent back, back depressed, tnil erect. 
Sawhor.se attitude of legs, hock turned out, producing bo wl egged n ess. 
Spasm of masseter and pharyngeal muscles interfere with mastication 
and deglutition, spasm of the respiratory muscles affects respiration. 
Great excitability; this agtjravating the general mu.scular cramps. At 
first no fever, later on the fever is high. Pulse strong and full. Animals 
do not lie down, or when down they can not get up. Mental condition is 
normal. 

I^abics is a strictly infectious disease characterized by disturbance of 
the central nervous system. I. Initial stage. Dogs are restless, 
moody, easily frij^htened, want to be out of doors, depraved appetite. 

2. Raving stage. Aimless running about, tendency to bite, some- 
times break their own teeth in the act, voice changed to a barking howl. 

3. Paralytic stage. lunaciation, lower jaw paralyzed, tongue ex- 
tended, hind quarters paralyzed Horses show restlessness as in colic, 
neigh in a peculiar shrill or yell i>i<^ manner, try to gnaw or bite the point 
of infection, bite the manger and not infrequently fracture the lower jaw 
in the act. Paralysis and death follow within three days. Cattle bellow 
and run against objects with their horns, frequently fracturing them. 
Sheep and l)igs al.so manifest a desire to bite 

Infectious cerebrospinal meningitis. Disease is frequently introduce*! 



180 



CLINICAL DIAGNOSTICS. 



with chills. Slight fever. Sensibility reduced, animals are drowsy, 
stumble and fall on slight provocation. Turning of eyes, jerking of 
muscles, later on paralysis. Tonic spasms of the cervical muscles; head 
drawn to one side. 

Intoxication Diseases. 
Parturient paresis, milk fever, is an acute auto-intoxication closely 
following the act of parturition, and characterized by cerebral paralysis. 
Begins with slight, temporary, cerebral excitement; after a few hours 
synjptoms of depression and paralysis set in. Animals lie immovably in 
a characteristic attitude, see p. 34 . Eyes closed, paralysis of muscles 
of head, tongue extended, rattling breathing, distention of abdomen, 
constipation, paresis of paunch. Lowering of external and internal bodily 
temperature. 

C. specific Examinations. 

We resort to the specific examinations only when definite 
results cannot be obtained with the foregoing methods, espe- 
cially in cases of differential diagnosis between similar diseases- 
In all cases the specific examinations are di- 
rected toward determining definite diseases; 
and the characteristics of these are specially 
considered . 

12. Body Movements. 

Many diseases are not observed until the animal is in 
harness or under the saddle, others become more conspicuous 
in their symptoms under these conditions. The rule is to 
examine animals while engaged in their accustomed occupation 
(blind staggers, balkiness). Draft horses should be examined 
when hitched to the wagon, riding horses under their rider. 
Unaccustomed work fatigues animals unduly and excites 
them. Sometimes fatigue and excitement make certain symp- 
toms more conspicuous (roaring) ; in such cases we make an 
exception of the rule just given. In all cases we must observe 
that the animal is properly harnessed. 

I. Examination for Immobility. 

(Examination of so called dummies). 
The symptoms of blind staggers are observable during 
rest but they increase when the patient is exercised. Mild 
cases of blind staggers can be recognized only after exertion 



BODY MOVEMENTS. 



181 



on part of the animal. It is of diagnostic importance that horses 
affected with immobility can be used for work, though in a 
limited degree, and that horses suffering with acute cerebral 
affections refuse to work or, if worked, symptoms of 
cerebral excitement follow. Again, horses with 
blind staggers always have a low pulse, eat slowly but 
nevertheless eat a f ul 1 f eed. On the other hand, horses 
with acute cerebral affections have poor appetite and a high, or 
changeable, pulse. 

In examining for blind staggers the horses must be tested 
while performing accustomed duties and care must be observed 
not to excite them; in no case must they be subjected to unac- 
customed work. It is advisable to drive or ride the animal 
oneself; notice the facility with which the animal is guided, 
effect of whip and spurs, tendency to go over to one side, ease 
with which animal moves forward or backward. As soon as 
the animal begins to sweat it is taken to a quiet place 
and rested, here we repeat a careful examination of the cere- 
bral functions, (the animal's psychical condition); ob- 
serve the expression of the eye. effect of surroundings, general 
attitude of the body, movements of the head, u.'^e of eyes 
and ears. To determine the degree of sensibility we resort to 
mechanical irritation: gently inserting a finger into the animal's 
ear, flipping the finger against the nose, stepping on the coro- 
net, kicking against the cannon bone. Finally the animal's 
motility is tested to determine whether it voluntarily as>^umes 
unnatural positions (setting a foot abnormally forward or 
back) whether it advances or backs readily, follows its leader 
or not, halts without a command when the attendant leading 
it stops, etc. An important test is to attempt to cross the 
forelegs; horses with blind staggers can usually be made to 
assume this po.sition and throw their weight on their feet 
when thus crossed. To make this test the operator stands on 
one side of the animal, his legs spread so that one is in front, 
and the other behind the front leg of the horse, then grasps 
the foot of the opposite side (at the metacarpus and from 



182 CLINICAL DIAGNOSTICS. 

behind), forces the horse back a little to relieve the foot in 
question, pulls it over and crosses it in front of its opposite. 

Fig. 42. 



Examination of a Horse for Blind Staggers. 

Quiet and gentle animals will sometimes remain standing 
in this position and even permit other insults, but from their 
general attitude it is plain that the reason for all this is not 
an abnormal mental state but rather extreme good natured- 
ness. Animals greatly fatigued may show S5'mptoms of a 
depressed sensorium but they are always of short duration. 

A single symptom can ne\'er determine a 



BODY MOVEMENTS. 183 

diag^nosis, we must consider the animal's con- 
dition as a whole. 

II. Examination for Balkiness. 

Balkiness is refractoriness manifested in common and 
accustomed work. Hence a horse must be tested while at 
acaisfof/icd work, and we must proceed with utmost caution and 
quiet and avoid everything that might excite the animal. 
The examining veterinarian must be present 
during all manipulations and .see to it that rough or 
improper treatment is avoided. 

We first examine those parts of the body that bear the 
weight and pressure of the harness and see that no morbid or 
painful conditions exist; the animal is then properly harnessed. 
In case the harness does not fit it should be made so by short- 
ening or lengthening parts that may require it, or by calling 
for another .set of harness. Then the animal is tested in the 
capacity for which it is intended, single or double, as coach or 
draft horse, or under the rider, as the case may be. Active or 
passive refractoriness to reasonable demands is regarded as 
da/kin ess. 

Young animals, such as are not yet sufficiently accus- 
tomed to work, also evince a certain degree of refractoriness, 
but, as a rule, if properly handled they will soon yield and 
obey willingly, especially if they are hitched with older and 
quiet horses. 

111. Examlnatfon for Heaves. 

Heaves is a chronic, a p y r e t i c , and, as a 
rule, incurable difficulty of respiration. 
The definition is a forensic one and includes a number of en- 
tirely distinct morbid conditions of the respiratory tract and 
heart. Although we can, as a rule, by careful examination 
determine the exact nature, or anatomical lesion at the bot- 
tom of heaves it is customary, in Germany at least, to apply 
the term "heaves" to all of the.se conditions becau.se "heaves" 



184 CLINICAL DIAGNOSTICS. 

is considered as one of those diseases the presence of which 
can set aside a contract of sale and is referred 
to under this name in all laws concerning it. 

In examining for heaves we must differentiate between 
two entirely distinct groups of diseases : 

1. Stenoses of the upper air passages; 

2. Diseases of the lungs and of the heart. 

I. Stenoses of the upper air passages as a rule do not 
manifest themselves until there is labored 
breathing, hence during work; they ate characterized by 
the occurrence of a respiratory noise or tone. We 
must first determine whether or not acute morbid processes 
exist in the upper air passages and whether or not the animal 
has fever. 

If the stenosis is in the nose it is frequently 
unilateral. When the animal is exercised a wheezing noise is 
heard — most distinct in inspiration, much less so in expiration. 
If the cause is unilateral the sound is unilateral and disappears 
when the nostril in question is closed, becoming more pro- 
nounced when the opposite one is closed. 

Stenosis of the larynx is by far more frequent; 
as a rule it is due to a paralysis of the left recurrent nerve and 
the resulting inactivity and degeneration 
o f the muscles which it supplies {la}y?igcal r oar- 
ing'). In rare cases a paralysis of the right recurrent nerve or 
a bilateral paralysis may exist; sometimes thickening of the 
mucous membrane or the presence of tumors may be the cause. 
An exact diagnosis of the cause of such a stenosis can b2 defi- 
nitely determined only with the aid of the laryngoscope; but in 
9g% of all cases a left handed paralysis is the cause. 

Except in rare cases laryngeal roaring is noticed 
only in forcible or increased respiration, and is then character- 
i zed by a harsh, sharp inspiratory noise or tone 
(wheezing, whistling, blowing, humming, roaring, snoring.) 
The respiratory noise is caused by the fact that deep and rapid 
inspiration causes the air current to force the paralyzed aryte- 



BODY MOVEMENTS. 185 

noid cartilage and vocal cord into the lumen of the larynx and 
thus obstructs its free passage. Decreasing the volume of the 
ingoing current of air by compressing the nostrils causes the 
noise to cease. Pressure on the paralyzed arytenoid cartilage 
increases the noise. Pressure on the right (unaffected) carti- 
lage increases dyspnoea to such an extent that inspiration is 
almost impossible, it ceases entirely or continues with a sharp 
wheezing sound, because the lumen of the larynx is now 
obstructed by both the arytenoid cartilages. 

In examining for roaring the horse must be placed under 
conditions that force it to make rapid and energetic respiratory move- 
ments, it must be "worked hard," pull heavy loads over soft ground, or 
gallop. Exercising or riding are especially adapted for this purpose be- 
cause we can control the position of the head, and thus influence respira- 
tion. Whether or not the animal is accustomed to this sort of exercise 
has no effect on the general result. 

If the head and neck of the animal are well checked up and back, the 
points of insertion of the dorsal muscles are approximated and the action 
of the latter on the spinal column is reduced: now, in order to fixihe spi- 
nal column the longissimus dor.si, the inspiratory and the abdominal nms- 
cles must be contracted with unusual force; this can be done only at the 
moment of inspiration. In expiration these muscles are relaxed and the 
animal loses, more or less, the control over its spinal column. It there- 
fore makes an effort to reduce the expiratory period by rajjidly and ener- 
getically following with the inspiratory movement. If only one arytenoid 
cartilage projects' over the lumen of the larynx the insjMratory current 
forces it in, produces a stenosis and causes the respiratory sound. By 
turning the head toward the right the in-streaming current of air is 
directed on the left arytenoid cartilage and if the paralysis is only an in- 
complete one the characteristic sound is produced just the same. 

This kind of treatment can never pro- 
duce roaring in a healthy horse. 

If existing lameness or the presence of acute affections of 
the respiratory apparattis or other organs make this method of 
examination impossible, the laryngoscope may do valuable 
service. See p. loi. 

2. Chronic affections of the lun^s and heart usually cause 
more or less respiratory difficult>' even dur. 
ing rest. Most frequently this form of heaves is due to 
chronic bronchitis, alveolar pulmonary emphysema, chronic 
pneumonia, or organic heart diseases, which, as a rule, can be 
recognized as such. In diagnosing heaves it is important to 



186 CLINICAL DIAGNOSTICS. 

exclude, by means of a careful examination of all functional 
apparatus, any acute affections that may produce increased 
respiration; external painful conditions must also be considered. 
If an animal is lame the diagnosis "heaves" 
may appear uncertain. 

To determine the existence of a respiratory difficulty the 
animals are worked in an accustomed manner and made to ex- 
ert themselves to a moderate degree, at the same time we note 
the character and frequency of respiration. The horse should 
be driven or ridden in a quiet trot; a draft horse made to pull 
a moderately heavy load. Count the respirations every 5 min- 
utes and let the animal work until it sweats, but not long- 
er than 15 minutes. Then put the animal in a stable, count 
the respirations every 5 minutes and note when they return to 
the normal (the number counted before exercising). 

In healthy horses the number of respirations runs 
as high as 50 or 70 per minute, sometimes even higher. Respi- 
ration occurs without exertion, the animals may now and 
then give a voluntary snort and take a few deep inspirations. 
In the course of at most 15 to 18 minutes after cessation of the 
exercise, the number of respirations should be reduced to that 
observed at rest. 

' ' H e a V e y ' ' horses, on the other hand, show increased 
or difficult breathing, dyspnoea, (see p. 84). Inspiration 
and expiration may be so difficult that the number is not in- 
creased, but the character of the respiratory movements ena- 
bles us to recognize the dyspnoea. But as a rule the number 
of respirations, when animals are exercised as above described, 
runs up to 80 to 120 per minute and goes back to the normal 
very gradually. Not infrequently this requires 30 to 60 minutes. 
In chronic bronchitis a white foamy nasal discharge js ob- 
served. 

IV. Examination for Epilepsy and Vertigo. 

E p i le p s y is a chronic cerebral disease that is character- 
ized by paroxysms occurring at intervals and attended with 
interruption or loss of consciousness and sensibility. V e r t i- 



BODY MOVEMENT. 187 

go (dizziness) is a similar aflfection; it is an independent dis- 
ease occuring in the form of periodical attacks, disturbed 
equilibrium and consciousness. The difference between epi- 
lepsy and vertigo is that spasms are absent in the latter. 

The diagnosis of these two diseases is not difficult 
if one has an opportunity to observe an attack. In the in- 
tervals horses act perfectly normal. Some- 
times certain known conditions bring about an attack; when 
making an examination of suspected animals we can often 
make use of this knowledge to bring on an attack. Horses 
may be hitched up and driven as on former occasions when an 
attack was observed, etc. The fit of the harness should be 
carefully inspected. Sometimes frightening or exciting the 
animal, or driving with the face turned toward the setting sun, 
or along streets sprinkled wath alternating shade of trees and 
the glaring light of the sun, will produce an attack. If we 
cannot personally o bs e r v e an a 1 1 a ck we must 
base our diagnosis upon unobjectionable 
statements of witnesses. 

Epilepsy. Characteristic epileptic spasms occur either onlv at the head 
and neck (partial epilepsy) or the whole body is aflfected ( jj^cneml e])i- 
lepsy). Animals stop suddenly, distort their eyes, blink, sjxismodically 
contract the muscles of the lips and face, raise their heads hi.Lfh ami jerk 
them to one side, sometimes they step to and fro. or backward and for- 
ward, restlessly. In general epilepsy the sjjasms rapidly extend over the 
whole body; masticatory movements are spasmodic, the saliva is churned 
into foam, the animals grate their teeth, spasmodically distort their 
neck sideways, the muscles gc-nerally undergo spasmodic contractions, 
the animals stagger and fall and then the .s])asms may coiUinue for some 
minutes. An attack may last from '4 to 15 minutes, the horses then get 
up and become quieted. The intervals between attacks are verv irregular. 

The above described idiopathic epilep.sy must be distinguished from 
acute cerebral affections and from, epileptiform spasms due to peripheral 
irritations ( reflex epilepsv ). 

Vertigo. Attacks usually occur while animals are at work ; they sud- 
denly walk slower, nod and shake their heads, snort, raise their heads 
up and sideways, .stagger, .spread their legs and not infrecjuentlv fall 
down. Here they li^ quietly, sometimes kick a little and then get up 
again. During the attack there is a loss of consciousness and sensibility, 
.sometimes increased resj)iration and profuse sweating. 

Attacks of dizziness due to congestion of the brain (conipre.ssion of 
the jugulars) and to cerebral ameinia (stenosis of aortic valves) do not 
belong under the head of idiopathic vertigo. 



188 CLINICAL DIAGNOSTICS. 

13. Diagnostic Inoculation. 

Diagnostic inoculations consist in the introduction of cer- 
tain substances into the bodies of animals for the purpose of 
determining either the character of the substance or the con- 
dition of the animal's health. We base our judgment on the 
character of the result. For the clinician diagnostic inocula- 
tions serve merely to recognize a few infectious diseases; cer- 
tain of these diseases have so rapid a course that the clinical 
symptoms cannot be relied upon to determine either their kind 
or character with any degree of certaintj'. Others which ter- 
minate much less rapidly do not show sufficient symptoms for 
a definite diagnosis. In these cases nothing save a 
correctly performed inoculation will serve to 
recognize the disease or to obtain an early 
diagnosis. 

Diagnostic inoculations are always made with respect to 
certain well known infectious diseases which our examination 
leads us to suspect. In performing the inoculation, therefore, 
we must consider the peculiarities of these diseases, we choose 
certain substrata for our inoculating material, we follow a cer- 
tahi method of inoculation and make use of particular animals. 
For inoculation we u'^e 

I ) . material of known composition (tuber- 
culin, mallein) in order to determine the condition 
of the animals from the resulting reaction. 
2). substrata of diseased animals on test 
or experimental animals in order to deter- 
mine the pathogenic character of the inoculated 
material. 
Diagnostic inoculations are of particular value in the 
infectious diseases which follow. 

1. Tuberculosis. 

On the basis of the results of ordinary meth- 
ods of clinical examination tuberculosis can be 



DIAGNOSTIC INOCULATION. 180 

diagnosed in only a small per cent of affected 
animals. On the one hand only a few symptoms can be 
determined, on the other hand these symptoms are not charac- 
teristic because they also occur in other diseases. The dis- 
covery of the tubercle bacillus as the cause of tuberculosis is 
hardly of any value in the clinical diagnosis of the disease in 
animals. Morbid products from an affected organ (lung of 
cow) for microscopical examination, are difficult to obtain; the 
quantity is small and besides is swallowed by the animal as 
soon as it reaches the pharynx. But, an opportunity to ex- 
amine pathological nasal secretions, ejections, vaginal dis- 
charges or pathologically altered milk must never be neglected. 
See p. 92. 

Under these circumstances the experimental deter- 
mination of this disease is of great importance. For 
this purpose we resort to the tuberculin test and to the 
inoculation of small experimental animals. 

The tuberculin test. Tuberculin is the toxin of the tubercle 
bacilli, obtained from artificial cultures of the same. The 
tubercle b.icilli are cultivated for six weeks in 5% glycerine 
beef bouillon at 38° C. [100.4° F-] The culture is then 
sterilized at 110° C [230° F.] and filtered through unglazed 
porcelain lubes. The filtrate is evaporated to I'o its volume 
and thus constitutes tuberculin. After these manipulations 
the tuberculin is absolutely free from germs and therefore it 
could never produce tuberculosis. Furthermore, it has no per- 
manent injurious influence on either sick or healthy animals; 
during the tuberculin test the quality of the milk is in no 
way afTected, but the quantity may suffer to the extent of 
a reduction of 10% or less, for a few days. In cattle with very 
advanced tuberculosis the disease has been observed to have 
become aggravated — according to reports. 

Dose.* The tuberculin prepared as above described is 

[ 'This applies, c,l course, to the German tubeiculin. In America the article is 
manafactured bv a number of reliable tirins. It should always bo used as fresh as 
possible and the dose regulated accordiuK to the strength of the material. This is 
Iways indicated In the "directions for use.") 



190 CLINICAL DIAGNOSTICS. 

diluted with 9 volumes of water to which j4% oi carbolic acid 
has been added. Cattle and horses receive 5CC of this solution, 
yearlings 2.5CC, calves icc and dogs 0.5 — icc. It is best to 
obtain the material from the dispensary of a veterinary college 
a short time before using it. 

Technique. The tuberculin is injected subcutaneously 
at the neck or in front of the shoulder. Before and after 
using, the hypodermic syringe should be disinfected with a 2% 
solution of carDolic acid. Before inserting the hypodermic 
needle smooth down the hair at the point of injection. Disin- 
fection of the injected area is not necessary if care is exercised 
otherwise. The best time for injection is in the evening be" 
tween 9 and 10 o'clock. The bodily temperature of the 
animal to be injected should have been ascertained at noon of 
the day of injection and also just before injection. Eight or 
9 hours after injection of the tuberculin, hence at 6 A. M., 
next day, the temperature of each animal should again be 
taken, and thereafter every two hours until the i8th hour 
after injection. Perhaps it is unnecessary to state that the 
temperatures should be recorded. 

Action. In tuberculous animals the injection of tuber- 
culin produces fever (reaction), healthy animals are not 
affected. If the temperature, after injection, 
at any time before the i8th hour, rises i.5°C. 
[2.7° F.] above the highest temperature re- 
corded on the previous day we may consider 
it as a distinct reaction and regard the ani- 
mal tuberculous. If the increase is only 1.0° — 
1.4 C. [i.8°— 2.5° F.] the result is doubtful. If 
the rise is less than 1.0° C. [1.8° F.] it is to be regarded as 
a physiological variation and considered as of no importance. 

According to A. Eber, in cattle that record no temperature above 
39.5° C. [103.1° F.] before inoculation, a temperature of 40° C. [104° F.] 
or more after inoculation must be considered as a reaction; again, all 
temperatures between 39.5° and 40° C. [103.1° — 104° F.] that are at 
least 1° C. [1.8 ° F.] above the highest of the preceding day must be con- 
sidered as reactions. k 



DIAGNOSTIC INOCl'LATION. 



I'.ll 



Doubtful reactions are all those between 39.5° C. and 40.0'^ C.[ 103,1° F. 
and 104° P.] that are from 0.5° and 1" C. [.9° and i 8° F.] higher than the 
highest teni]}erature of the preceding <lay. 

Tein]ieratures less than 39.5° C- [103.1= F.] or, higher teni])eratures 
due to increases of less than 05° C. [9 F.] are pliysiological. 

Reliabilty. The tuberculin test cannot be regarded 
as absolutely infallible. About yo^' of the tuberculous ani- 
mals give a reaction. Animals in advanced stages of the dis- 
ease frequently do not react. As a rule, however, a physical 
examination of such animals reveals symptoms which, when 
considt^red alone, would at least awaken suspicion as to the 
exis ence of the disease. Of the animals that do not respond 
to the tuberculin test about 10'/ ['] may be considered tuber- 
culous. Nevertheless tuberculin is the best 
d i a K 11 o s t i c u m in our possession. 

Inoculation of experimental animals. Tlie milk of tuberculous 
cows contains tubercle bacilli when the udder is affected with 
tubercular processes, and also in .>^ome cases where tubercular 
processes in this organ seem to be absent. Microscopical ex- 
amination of milk for tubercle bacilli is very difficult and the 
results unreliable, therefore we resort to intraperitoneal inocu- 
lation of Guinea pigs with the frcsh milk of a suspected 
animal. If tubercle bacilli are contained in the milk tubercu- 
lar nodules will develop on the peritoneum (omentum), spleen 
and liver in the course of two weeks. If the Guinea pigs do 
not die before, they are killed at the end of six weeks and 
carefully examined for tuberculosis. 

2. Glanders. 

In view of the great infectiousness and incural)ility of 
glanders the object of the veterinarian is to determine the 
pre.sence or absence of this disease at the earliest possible date. 
However, hor.ses affected with glanders show no symptoms or 
at least no characteristic symptoms in the early stages of the 
disease; for this reason hor.ses that have been exposed 
to an infection with glanders are subjected 
to a m a 1 1 e i n test, with the object of thus enabling us 



02 CLINICAL DIAGNOSTICS. 

to recognize the disease. If the animals show s5miptoms of the 
disease we endeavor to obtain some of Uae pathological pro- 
ducts or secretions and with them inoculate experimental 
animals which are known from experience to be susceptible to 
the disease and develop it in a characteristic form. 

Mallcin inoculation. Mallein is the toxin of the bacilli of 
glanders and is obtained from their cultures in a manner 
analogous to that employed for obtaining tuberculin. The 
crude preparation is a fluid, obtainable from the manufacturer 
and injected in doses designated. It ma}- also be obtained in 
the dry or powdered form and is thus injected in doses of 
0.02 — o I G. according to the weight of the animal. It is 
best to have the solution of the dry tuberculin prepared by 
the manufacturer. 

Technique. This is the same as for tuberculin inocu- 
lation. Taking temperature of animal to be tested, two or 
three times at definite intervals before inoculation; inoculation 
between 10-12 P. M., and taking temperatures again on next 
day beginning at 5 A. M., and repeating every two hours until 
6 P. M. 

An increase of temperature equaling or exceeding 1.5° C. 
[2.7° F.] is considered as a reaction. The reaction is said to 
be typical if the rise in temperature is a rather rapid one, 
drops slightly, goes up again, and then slowly and gradually 
returns to the normal. The results of the mallein 
test cannot be compared with those ot the 
tuberculin test, they are far less reliable. 

Inoculation of experimental animals. A male Guinea pig is in- 
oculated subcutaneously at the abdomen with nasal secretion, 
pus, etc. from a suspicious subject. If the inoculated material 
contains the bacilli of glanders a local abscess will develop at 
the point of inoculation and a firm hot swelling appear in the 
region of the thigh. After 2-4 weeks the Guinea pig is 
killed with chloroform. The presence of the charactei istic 
nodules etc., of glanders, in the region of the point of inocula- 
tion and in the testicles confirms the diagnosis. Cats are also 



DIAGNOSTIC INOCULATION. 103 

suitable animals for test inoculations. We inoculate at the 
back of the neck. 

3. Anthrax. Blackleg, Malignant CEdema and Wild-und 
l^indcr-scuchc. 

On account of their rapid course the clinical diagnosis of 
these diseases is often impossible; besides, the symptoms of 
the different diseases are often nuich alike and hence a dif- 
ferentiation impossible. Altliough a microscopical examina- 
tion of the blood (or exudate) of animals that died of one of 
these diseases suffices to r«rc<5gni/.e their character by finding 
the characteristic organisms, still there are cases where an iti- 
oculation alone can decide the question. We u.se rabbits for 
this purpose and inoculate them cutaneously (!) in the ear, 
with blood or exudate from the animal or carcass in question. 
If the rabbit dies the disease is either anthrax or Wildseuche 
because blackleg and malignant (td^^nia are not transmissible 
by means of cutaneous inoculation. The differentiation 
between anthrax and Wildseuche is made by a bacterioscopic 
examination of the dead rabbit. It is also worthy of note 
that in Wildseuche there is always a severe tracheitis. 

In case the rabbit does not die, it is again 
inoculated; this time s ubcu t aneo u s 1 y; if death follows, 
it was a case of malignant oedema because rabbits are immune 
against blackleg. The presence of blackleg can be demon- 
strated by inoculating a Guinea pig with the suspected 
material; death following in a few days after inoculation. 

We can expedite matters by simultaneously inoculating 
one rabbit cutaneously and another rabbit and a Guinea pig 
subcutaneously. If all three animals die we had anthrax (or 
Wildseuche) if only the two subcutaneously inoculated ani- 
mals die it was a case of malignant redema, and in case it was 
blackleg only one animal, the Guinea pig, is sacrificed. 

* If we desire additional proof by having the blood of a 
suspected anthrax carcass examined by a second person we 

* [This method is commonly resorted to in Uermany.J 



194 CLINICAL DIAGNOSTICS. 

may boil a potato, upon cooling cut it in halves with a steri- 
lized (flamed) knife, apply some of the suspected material to 
the surface of one half, replace the other half, pack carefully 
and send it to the official bacteriologist. Blood sent in a flask, 
is usually not adapted for microscopical examination. 

4- Rabies. 

Suspected dogs are usually killed before they can be sub- 
jected to examination by an expert. A post mortem examin- 
ation will then hardly enable us to make a definite positive 
diagnosis: we must resort to inoculation of a test animal. 
The diagnostic inoculation of a rabbit with 
the brain matter of a suspected dog is the 
only absolutely safe method of definitely 
determining the presence of rabies. 

Method according to Johne. The brain and cer- 
vical cord of the suspected dog are carefuU}' removed. The 
medulla oblongata is severed from the brain by an incision, at 
the pons Varolii, made with a "flamed" knife. A piece of the 
medulla (size of a pea) is removed with sterilized scissors from 
the cut surface, placed into a sterilized porcelain vessel and 
thoroughly triturated with a small quantity of distilled water. 
Of this fluid two rabbits receive a few drops each into the an- 
terior chamber of the eye; injected with a sterilized hypoder- 
mic syringe. If the hypodermic needle is fine and sharp and 
providing that the rabbit's eye has been previously disinfected 
and anaesthetized the operation can be performed with little 
difficulty. We insert the needle at the border of the cornea 
directing it toward the median line. If the operation was 
carefully conducted a slight turbidity of the cornea which soon 
disappears is the only symptom that follows. 

If rabies is present the first symptoms appear in from 2 
weeks to 23 days; the animals are shy, crawl away, and show 
loss of appetite. After 12 hours paralysis and difficult deglu- 
tition is observed, the animals emaciate rapidly, grit their teeth 



THE LYMPHATIC GLANDS. 195 

and cry when touched on the head. The disease thus produced 
by inoculation leads to death within 48 hours. 

14. The Lymphatic Glands. 

In horses the intermaxillary lymphatic glands are always 
subjected to an examination in diseases of the respiratory ap- 
paratus. Otherwise they are subjected to special examin- 
ations only when infectious diseases, glanders and 
tuberculosis, constitutional blood diseases ( 1 e u c se - 
m i a ) or the presence of malignant tumors (carcinoma 
and sarcoma) are suspected. Examination consists in 
palpation (conducted according to the rules given on p 21. 
The correct interpretation of these changes was dij^cussed 
under "intermaxillary hmphatic glands." 

When an examination is called for. the followinj^ 1 y ni j) h a t i c 
glands must be considered : 

1 ) Intermaxillary Hmphatic glands, 1 y ni p h o - 
g 1 a n d u 1 a s u b m a x i 1 1 a r i s . In the ox these are of the size of half 
a walnut and are situated on the median side of the subniaxilla, near its 
border and in the region of the point of insertion of the muse, sterno- 
maxillaris. 

2) Lymphatic glands of the parotid region, lymph- 
oglandula parotideae. These are between and below the 
lobules of the parotid gland. In the ox they have the shape of a flattened 
tongue and a length ajjproaching 6 cm.; this gland projects from beneath 
the border of the parotid gland, below the maxillary articulation. 

3) The superior cervical glands, lymphoglandula 
cervicales superiores, and retropharyngeales are 
situated, as the name implies, on the posterior wall of the pharynx. In 
the ox they consist of a closely united packet, about 5 cm. long, under 
the lateral processes of the atlas, where they can be felt by placing the 
thumb on the lateral process of the atlas (both sides simultaneously) 
and thus pressing the finger tips behind the pharynx and then against 
the inferior face of the lateral processes of the atlas. 

4) In the ox a few large lymph follicles in the depression in front 
of the shoulder ( prescapular glands) and on the chest in front 
of the elbow articulation Iprepectoral glands). 

5) The lymjihatics of the shoulder (prescapular 
glands ) are covered by the mastoido-humeralis muscle in front of the 
scapulo-humeral articulation. 

6) The precrural glands lie at the anterior border of the ten- 
.sor fascia lata muscle; distinctly visible in rattle. 

7) In the upper part of the flank of the ox four or five 
follicles as large as a lentil can frequently be felt snbcutaneously. 

8) The deep inguinal glands lie in the crural canal cover- 
ing the crural vessels. 



196 CLINICAL DIAGNOSTICS. 

[The superficial inguinal glands in the male animal at 
the neck of the scrotum on each side of the penis in the sheath. In the 
female as follows :] 

9) The retromammary glands (glands of the udder) are 
especially well developed in the cow and are situated behind and above 
the udder. 

loj The mesenteric, lumbar and sacral glands 
of the horse and cow can be examined per rectum. In the former the 
bowel should be evacuated by means of a cathartic; for the latter it is at 
least advisable to do so. 

In the healthy horse we can distinctly feel the intermax- 
illary glands, in the healthy ox the precrural glands, a n d n o 
others; if any of the other glands are distinctly p a 1 p a - 
b 1 e we assume that they are enlarged. 

The intermaxillary lymphatic glands of 
the horse are sometimes extirpated in order 
to subject them to a special macroscopical, or microscopical 
and bacteriological examination. For diagnostic purposes we 
resort to it in glanders only. We operate on the standing ani- 
mal and report to Schleich's anaesthesia. 

15. The Blood. 

The examination of the blood is of importance in a few 
rare cases only. A microscopical examination to determine 
the presence of certain infectious diseases is of value only in 
anthrax and Rothlauf in pigs, and even in these diseases the 
circulating blood contains only few organisms. However, i n 
Texas fever it is of diagnostic importance, and in con- 
stitutional blood diseases it is equally invaluable. 

The best way to obtain the necessary blood is to make a 
slight incision into the lip, with the point of a knife, observing 
care not to stretch the skin during the operation. If a larger 
quantity of blood is desired a hypodermic needle, inserted into 
the jugular vein answers the purpose better. [As far as an- 
noyance of the animal is concerned tapping the jugular vein 
is preferable in all cases.] In practice we may limit our- 
selves to the microscopical examination; for this purpose a 
single drop of blood, placed directly on the glass slip or 
cover will serve the purpose. From this drop we can 



THE RLOOD. 



197 



make a few cover o;lass preparations, allow them to drj', 
take them home, fix, stain and examine them at leisnre; 
or we may add a 0.3% solution of sodium chloride and 



Fijr 43. 




Leiicteiiiic Rlood. 



examine the blood in its 
inations are difficult and 
and minuteness that the 

Fi.^. 44. 



s^ Q • 



Red 



Abnormal Forms of 
Corpuscles. 

each microscopic field. I 

are present their number 

To determine the exact 



fluid coiulition. Exact blood exam- 
nuist be carried out with such care 
practitioner is obliged to get along 
with the results of the simplest 
methods. F'or those who care to 
take up the study of blood exam- 
inations in detail we reconmiend 
' ■ Jacksch-Klinisclie Diagnostik. ' ' 

Number of blood corpuscles. In 

normal blood the proportion of white 

to red corpuscles is as i : 300 or 400. 

By using a '6 iu. objective this 

gives us about 3 white corpuscles in 

f a greater number of white corpuscles 

i^ morbidly increased (leucocytosis). 

number of corpuscles in a measured 



198 CLINICAL DIAGNOSTICS. 

quantity of blood certain kinds of blood counting apparatus 
are required (Thoma-Zeiss blood counting apparatus). 

Shape of blood corpuscles. In pernicious anaemia the shape 
of the red corpuscles undergoes many changes; we find some 
unusually large in size (macrocytes) often containing a nucleus, 
others smaller than normal (microcytes) and still others of 
distorted form, pear and kidney shaped, angular or toothed, 
club shaped etc. (poikilocytes). 

Diseases of the Blood. 

Essential (idiopathic ) anaemia. Bloodlessness. Consists in a diniinish- 
ment of the quantity' of blood without a determinable cause. Blood pale 
and coagulates poorly. Mucous membranes pale and low temperature. 
Pulse small, heart tones metallic sound. Appetite poor. Tendency to 
dropsical swellings. General Aveakness. Mostly in young animals. 

Pernicious anaemia. Primary ansemia of adult animals with fatal ter- 
mination. Fever not constant. Mucoxis membranes pale and somewhat 
yellowish. Pulse gradually becoming more rapid, appetite less and less. 
Increased weakness terminating in death. Blood watery, changes in 
red corpiiscles characteristic: usually' large ones with nuclei, and small 
irregular forms, seem elongated, angular or toothed, club or pear shaped. 

Leucaemia. Chronic alterations of the blood and increased white 
corpuscles. Animals are languid, lazy, sweat easily, pale mucous mem- 
branes. Appetite grows less, pulse increases small. Heart tones 
metallic sovmd. Enlargement of lymphatic glands usually present. 
Sometimes ecchymotic hemorrhages in the mucous membranes. 

Texas fever. Is an infectious disease of cattle, caused by Pyrosoma 
bigeminum [indirectly by the presence of Texas fever ticks, Boophilus 
bovis]. Period of incubation 10-15 da}'S. Hierh and continuous fever, 
rapidly progressing anaemia, red corpuscles reduced in number from 6 
million to one million per cc. Hemaglobinuria. Fatal termination 
the rule. 

Pyrosoma bigeminum is a minute pale protozion of a round_ 
ish form found in the red corpuscles. It possesses amoeboid movemen 
and can thus assume irregular shapes. When fully developed the parat 
sites occur as two pear shaped bodies with their pointed ends converging- 
Fig- 45 




Different Stages of Development of Pyrosoma bigeminum 
in Red Blood Corpuscles. 

They are 2.5 to 4 ," long and 1.5 to 2 /^ wide. In the circulating blood 
I to'2 % of the blood corpuscles are infected, in the capillaries of the 
various organs more than half of them contain the parasites. 



INDEX. 



Abdomen 127. 

Abnormal sensitiveness 130. 
Accnmulation of food 128. 
Achorion Schoenleinii, see 

Favus 48. 
Acne contagiosa eqiior, see 

Canadian horsepox 49. 
Actinomyconia 124. 
Actinomycosis 118. 
Albnminnria 58, 152, 153. 
Albnmosuria 154 
Alkalies, craving for 1 18. 
Alopecia 39, 44 
Alveolar periostitis 119. 
Anaemia 52, 198. 

— ,pernicions 54, 198. 
Anaesthesia 173. 
Anamnesis 17. 
Anasarca 41. 
Angina pharyngea 142. 
Anti-and post-partum paresis 

.34- 
Anthrax 61, 193 
Anus 87. 

Apoplexy 176, 179. 
Appetite 1 16. 
Arteries 66. 
Ascites 128, 134. 
Atelectasis 29, 109. 
Auscultation 26. 

- of abdomen 134 
— of heart 73. 

— of lungs 107. 
Azoturia 7,1,, 54. 

Bacillus pyelonephritis 164. 
Balkiness 1S3. 
Bird lice 45. 
Blackleg 50, 193. 



Bladder, diseases of 147, 148, 

152. 
— , examination of 164. 
Blind staggers 178. 
Blood 196. 
Blood sweating 44- 
Blowing sound 82. 
Bodily temperature 55. 
Bovine pest 50. 
Broken back 34. 
Bronchial catarrh 108, 113. 
Bronchiectases 107. 
Bronchitis 108, 113. 

— verminosa 113. 
Bruits, anaemic 76. 
— , diastolic 74. 

— , inorganic 74. 
— , systolic 74. 

Cachexia 36. 
Canadian horse pox 49. 
Carbonate of lime 158. 
Cardiac dullness 72. 
Catarrh of mnxillarv sinuses 

112. 
Caverns in lungs 107. 
Cerebral congestion 178. 

depression 172. 
— hemorrhage 176. 
Cerebrospinal meningitis 179. 
Chills ,s8. 

Circulatory apparatus 63. 
Clitoris 147. 
Coital exanthema 170. 
Colic T,2, 143, 147. 
Collapse, temperature of 60. 
Coma 172. 
Condition 35. 
Conformation 35. 



200 — 



Congestion, cerebral 178. 
Conjunctiva 51. 
Constipation 128, 132,137, 139. 
Cough 97. 

— , return impulse of 100. 
Cracked pot resonance 107. 
Cramp of the neck 34, 174. 
Crisis 60. 
Crusts 44. 
Cystitis 165. 

Deglutition, difficulties of 

120, 121. 
Diabetes 149. 
— insipidus 148, 149, 166. 
— mellitus 149, 166. 
Diaphragm, rupture of 107. 
Diarrhoea 137, 138, 139. 
Dicrotic pulse 68. 
Differential diagnosis 16. 
Digestive apparatus 116. 
Dilatation of the heart 76. 
Direct diagnosis 15. 
Dislocation of bowel 144' 
Distemper of dogs 55, 106, 

115, 140, 148. 
— of horses 1 15. 
Distoma, eggs of 141. 
Diverticula of oesophagus 125, 

143. 
Dizziness 179. 
Drowsiness 172. 
Dummies 31, 67, 178, 180. 
Dyspepsia 143, I44> 
Dyspnoea 84. 
Dysuria 147. 

Ecchymoses 54, 93. 
Echinococcus disease 114< 142. 
Eclampsia 179. 
Eczema 45. 

Emphysema 72, 105, 109. 
— , alveolar II4. 



— , cutaneous 22, 43. 
— , interstitial II4. 
— , of skin 42. 
— , septic 43. 
Encephalitis 31. 
Endocarditis, acute and 

chronic 77* 
Endometritis 169. 
Enteritis, hemorrhagic 140. 
Enteroliths 134. 
Epilepsy 179, 1 86, I87. 
Epithelial casts 163. 
— cells 161. 
Eruction 126. 

Esbach's albuminimeter 153. 
Excitability, abnormal 181. 
Exhalations 87. 
Expired air, odor of 87. 

Facies hypocratica 38. 
Fagopyrism 45. 
Fainting 173. 
Favus 48. 

Feces 136, 137, 140. 
— , retention of 137. 
— , voiding of 137. 
— , volume of 138. 
Fermentation test 158. 
Fever 57. 

— curve 59. 
—.types of 59. 
Fluctuation 22. 

Food, manner of taking 118. 
Foot and mouth disease 48. 
Foot eczema 45. 
Foreign bodies in intestines 
130. 

— in oesophagus 143. 
Fowl choleia 55, 62. 
Friction bruits of pleura 1 1 1 , 

Garglings 83. 
Gastro-enteritis 144' 



— 201 — 



Gastro-iutestinal catarrli 143, 

144. 
Glanders 94, 95, 96, 115, (91. 
— ulcer 94. 
—cicatrices 95. 
Gmeliii's test 156. 
Gram's nietliod 164. 
Granular casts 163. 
Granule casts 163. 
Grape sugar 157. 
Groaning 8r , 84. 
Grunting 81. 
Guttie of ox 133, 144. 

Habitus 30. 
Ha?matopinus 45. 
Hair coat 38. 
— , shedding of 38. 
Heart 71. 
— beat 72. 
—sounds 73. 75- 
Heave line 86. 
Heaves 183. 
Hematuria 154, 166. 
Hemidrosis 40. 
Hemiplegia 176. 
Hemoglobinuria 155, 166. 
Hepatization 29. 
Herpes tonsurans 48. 
Herring gutted 36. 
Hippuric acid 160. 
Hives 44. 
Hog cholera 62. 
Hyaline casts 163 
Hydrocephalus 119, 178. 
HypCL'Sthesia 173. 
Hyperaemia of kidneys, 

passive 165. 
Hypera-'Stliesia 173. 
Hyperidrosis 39. 
Hypertrophy of heart 76. 
Hj-pidrosis 40. 



Icterus 53, 139, 157, 173. 

hnmobility 180. 

Incarceration 133. 

Incontinentia urinae 148, 166. 

Indican 156. 

Influenza 55, 59, 62. 

Inoculation 188. 

— for anthrax, etc. 193. 

— for glanders 191. 

— for rabies 194. 

— for tuberculosis 188. 

Insufficiency 74, 75. 

— of mitral valves 75. 

— of semi-lunar valves 75. 
— of tricuspid valves 70, 77. 
Intermaxillary lymph glands 

95- 
Intestinal catarrh 143, 144, 

— evacuations 136, 137, 140. 
— gases (42. 

— noises or sounds 135. 

— peristalsis 136. 
Invagination 133, 144. 
Ischury 147. 

Kidnevs, passive hvperitmia 

of 165. 
Kyphosis 36. 

Laryngeal catarrh 113. 

Laryngeal fremitus loi. 

Ivarj-ngitis, croupous 113. 

Laryngoscopy lor. 

Leucocytosis 197. 

Leucccmia 198. 

Lice 45. 

Licking disease 144. 

Lime casts 163. 

Liver 142. 

Lockjaw 179. see tetanus. 

Loco weed poisoning 145. 

Lordosis 36. 



I 



— 202 — 



Lumbago 33, 54, see azotiiria. 
Luugs, congestion of 113. 
— , gangrene of 88, 110, 113. 
— , oedema of 113. 
lyUpinosis 145. 
Lyniphatic glands 195. 
Lysis 60. 

Macrocytes 198. 

Macula 44. 

Mai d 11 coit 170. 

Malignant catarrhal fever 115. 

— carbuncle 42. 
— oedema 50, 193. 
Mallein inoculation 192. 
Malleus 1 15. 

Mange 47- 

— , acarus 47« 
— , psoroptic 47. 
— , sarcoptes 47« 

— , sarcoptic, of fowls 47* 

— , symbiotes 47' 

Mastication 118. 

Mastitis I70. 

Melanosarcoma 124. 

Microcytes 198. 

Milk fever, see parturient 
paresis. 

Mold poisoning, see mycosis. 

Monoplegia 176. 

Morbus maculosus, see pur- 
pura hemorrhagica 42, 50, 
54. 94. 123. 

Motility 174, 181. 

Mouth cavit}?^ 121. 

Mycosis 121. 

Mucous click 83. 

Muscular .'^ense 176. 

Myocarditis, acute 76. 

Nasal catarrh 112. 

— discharge 89. 

— mucous membrane 93. 



— tone, see mucous click 83. 
Nephritis 165. 

Nettle rash 44, 49. 
Nervous system 170. 
Nodules, see papules 44. 
Nymphomania 166. 

Obesity 35. 

Ocular vertigo 173. 

CEdema 42. 

— , collateral 42. 

-of glottis 113. 

CEsophagus, foreign bodies in 

124, 143. 
CEstrus ovis, larvae of 90. 
Opisthotonus 174. 
Orthotonus 174. 
Osteomalacea 36. 
Overfeeding 128, 131. 
Oxalate of lime 160. 

Palpation 21. 
Panting 8i, 82. 
Papules 44. 
Paraplegia 176. 
— laryngis 102. 113. 
Paralysis 176. 
— of bladder 148. 

— of facial nerve 118, 119, 179- 

— of ihe larynx 1 13 

— of oesophagus and pharvnx 

143. 
— of paunch 126. 

— of recurrent -nerje 184. 
Parasites, intestinal 14 [. 
— in cavities of head 112. 
Paresis 176. 

Parturient paresis 34. 121, 180. 
Pathognomic symptoms 14. 
Paunch, paresis of 131. 

— , peristalsis of 130. 
Pentastonium tsenioides 90 
Percussion 22. 



— 203 — 



Percussion, field of 104. 

— of abdomen 134. 
Pericarditis 42, 77- 

— , traumatic, of ox 77- 
Peritoneal hernia 144. 
Peritonitis 31, 136. 
Pernicious anaemia 198. 
Petechiae 54, 93. 
Pharyngitis 121, 124, 142. 
Pleuritis 31, 42, 112, II4. 
Pleurodynia 31, 113. 
Pleuropneumonia of the ox 

115. 
— of the horse 54, II4- 
Pneumonia 107. 
— , catarrhal 113. 
Pneumothorax 87, 105, II4> 
Poikilocytes 198. 
Priapism 166. 
Proctitis 140. 
Prurigo 44. 
Pseudo fluctuation 22. 
Psychic functions 171- 
Ptyalism 142. 
Pulmonary, congestion and 

oedema 113. 

— gangrene 88, no, 113. 

— resonance 105. 
Pulse 63 

Pumping of flanks 86, 87. 
Purpura hemorrhagica 42, 50, 

54. 94. 123. 
Pustules 44. 
Pyaemia 61. 
Pyelonephritis 166. 
Pyrosoma bigeminum 198. 
Pyrocatechin in horse urine 

158. 

Quality of percussion sounds 

25- 
Quibbing 1 19. 

Rabies 179, 194. 



Rachitis 36. 
Rales no, 1 1 1 . 

— , crepitant 1 1 1. 
— , dry III. 

— , moist I ID. 
Reflex excitability 177. 
Reflex spasms 175. 
Regions of the body 19. 
Regurgitation 120, 125. 
Resistance in percussion 26. 
Respiration, types of 81. 
— , amphoric 1 10. 
— , bronchial 109. 
— , vague or indefinite no. 
— , vesicular 108, 109. 
Respiratory apparatus 78. 
Relentio urinae 165. 
Return impulse 100. 
Rhinitis 83. 

Riding school movements 175. 
Rinderpest 144. 
Rinderseuche 193. 
Ringworm 48. 
Roaring 86, 99, 113, 185. 
Roihlauf 40, 173, 196. 
Rumination 125. 

Saliva, secretion of 122. 
Satyriasis 166. 
Saw-horse attitude 174. 
Scabs 44. 
Scalma 114. 
Sensibility 173. 
Septiccemia 61. 
Sexual apparatus 166. 

— desire 166. 
Sheep pox 48. 
Signalment 28. 
Skin 38. 

— , color of 40. 

— . exhalations of the 41. 
— , moisture of 39. 

— , sclerosis of 41. 



204 



Skoliosis 36. 

Sleepiness 172. 

Sneezing 83. 

Snoring 82. ' 

Snorting 82. 

Somnolenc}' 172. 

Sopor 172. 

Spasms 174. 

Spinal paralysis 34. 

Spine, fracture of 34. 

Spleen 142. 

Stasis 42. 

Stenosis of air passages 184. 

— of cardiac valves 77. 

— of oesophagus 125, 143. 
Stenotic lar^aigeal tone 83. 
Stethoscope 27. 
Stomacace 122. 
Stomatitis 142. 

— pustulosa contagiosa 145. 
Strangles 115, see distemper. 
Stranguria 147. 
Submaxillary lymph glands 

95- 
Suffusions 94. 
Sulphate of lime 161. • 
Summer surfeit 45. 
Sweating 39, 40. 
Sweeny 43. 
Swine erysipelas 40. 
Swine plague 62. 
Symptoms 12. 
Syncope 173. 

Teeth 123. 

— , caries of 88. 

— , diseases of 119, 143. 

— , gnashing of the 120. 

Temperament 36. 

Tetanus 33, 118, 121, 179. 

Texas fever 62. 198. 

Thirst, see "Desire for water 

Torsion of colon 133. 



Torsio uteri 168, 169. 
Trembling 174. 
Trichodectes 45. 
Tricophyton tonsurans 48. 
Triple phosphate 160. 
Trismus 174. 
Trommer's test 158. 
Tubercle bacilli 92. 
Tuberculin test 189. 
Tuberculosis 114, 188. 
Tumors in cavities of head 

112. 
Turn sick 179. 

T3'mpanitis 128, 131, 136,144. 
— acuta 144. 
— chronica 144. 

Udder 168. 

Ulcers 44. 

— catarrhal or erosion 95. 

Upper air passages 92. 

Ursemia 173. 

Urethral calculi 147, 165. 

Uric acid 160. 

Urinary apparatus 145. 

— casts 163. 

Urination 147. 

Urine, sediment in 159. 

— , voiding of 147. 

Urticaria 44, 49. 

Vaginal mucous membrane 

168. 
Vaginitis 169. 
Valvular disease 77- 
Veins 69. 

— , undulation of jugular 70. 
Venous pulse 70. 
Verminous bronchitis 113. 
Vertigo 173, 179, 187- 
Vesicles 44. 
Vesicular eruption 168, 169, 

170. 



— ^07) 



Vesicular niunnur 107. 
— respiration 108. 
Voice, chanci^e in 100. 
Vomiting 126. 
— in horses 126. 

Water, desire for 117. 
Whistling 83, 184. 



Woody tongue 118. 

Wool eating 133. 

Wool in feces 141. 

Wheezing 82. 

Wild-und Rinder-seuche 50, 

193- 
Yawn 82. 



OCT 18 1901 



OOt 29 I; . 



LIBRARY OF CONGRESS 



002 824 381 9 ^ 



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